CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 653 296.250000 13384.3000 45.1791
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 228 206.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 516 1292.500000 59041.4000 45.6800
Subtotal (Total Children Is Unduplicated) 894 1794.750000 72425.7000 40.3542
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 4 2.500000 125.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 329.5600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 11.500000 689.0800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 73.000000 5911.5400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 29 51.500000 4170.4700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 17.000000 1376.6600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 27.000000 2186.4600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 10.500000 850.2900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 36 64.000000 3834.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 56 102.000000 6111.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 116.2200 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 10.3600 10.3600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 538.8500 53.8850
Subtotal (Total Children Is Unduplicated) 136 400.000000 28004.6500 70.0116
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 14.000000 849.9500 60.7107
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 63 61.250000 3062.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 27 28.500000 1425.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 43 40.250000 1999.9000 49.6870
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 25 59.500000 2975.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 18.500000 925.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 22 54.000000 2700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 11.000000 550.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 5 2.500000 125.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 19.000000 950.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 9 8.500000 425.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 42.000000 1134.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 199 854.000000 46116.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 16.000000 864.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 439 2340.000000 35088.0000 14.9949
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 273 1044.000000 12389.3400 11.8672
OCCT-97530-OT SESSION BY LICENSED OT 16 48.500000 3944.0200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 8.000000 650.5600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 7 15.500000 1136.2000 73.3032
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 19.500000 1399.1300 71.7503
TRAV-TRAVS-Travel by mile 617 51629.00000 22982.2700 0.4451
Subtotal (Total Children Is Unduplicated) 717 56333.50000 141690.8700 2.5152
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Total 58528.250000 242121.2200 4.1368
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Number of Children (Unduplicated) With at Least One Service 1105
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Center 05
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 7492 52794.250000 159762.1700 159762.1700
D 14 4.750000 216.9800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4111 5724.000000 81913.7700 9933.4500
Other 13 5.250000 228.3000 -0.1000
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Total 11630 58528.250000 242121.2200 169695.5200