CMS/EIP Fiscal Report              Center: 06 
Services beginning 10/01/2025 ending 12/31/2025                Date of Report:01/07/2026   Page:   1
            List order: No List
    Agency Filter:EXT       
    Eligibility Filter:Part C (excluding not eligible)
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
Screening, Eval, and Assessment,Class #02
  AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY                1               1.000000           21.4600           21.4600
  AUDE-92555-SPEECH AUD THRESHOLD (DETECTION)              1               1.000000           16.1500           16.1500
  AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING)              1               1.000000            7.9200            7.9200
  EXIT-EXIT-COS Exit                                      89              90.000000         4500.0000           50.0000
Subtotal (Total Children Is Unduplicated)                 90              93.000000         4545.5300           48.8767
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EI Services,Class #03
  COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE            46              49.250000         2462.5000           50.0000
  COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE          74              78.250000         3787.5000           48.4026
  COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE                15              16.250000          406.2500           25.0000
  CONIF-CONIF-CONSULT, ITDS FACE TO FACE                   4               5.000000          250.0000           50.0000
  CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE               10              12.500000          625.0000           50.0000
  CONIP-CONIP-CONSULT, ITDS PHONE                          2               2.000000           50.0000           25.0000
  CONOF-CONOF-CONSULT, OT, FACE TO FACE                    1               1.000000           50.0000           50.0000
  CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE                  8              13.000000          650.0000           50.0000
  CONOP-CONOP-CONSULT, OT, PHONE                           1               1.000000           50.0000           50.0000
  CONPF-CONPF-CONSULT, PT, FACE TO FACE                    1               1.000000           50.0000           50.0000
  CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE                  2               2.500000          125.0000           50.0000
  CONPP-CONPP-CONSULT, PT, PHONE                           1               1.000000           25.0000           25.0000
  CONSP-CONSP-CONSULT, SLP, PHONE                          1               1.000000           25.0000           25.0000
  EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF          835            5285.250000       282546.7000           53.4595
  EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF        227            1028.750000        54094.5000           52.5827
  EPIC-99601-Early Steps Professional Development Fee    663            4329.000000        64365.0000           14.8683
  INTR-T1013-INTERPRETER                                  31             151.000000         9357.0000           61.9669
  NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE             218            1181.000000        14052.0000           11.8984
  OCCT-97530-OT SESSION BY LICENSED OT                     4              20.000000         1545.0800           77.2540
  OCCT-97530GT-OT SESSION BY LICENSED OT                   3              11.000000          569.2400           51.7491
  OCCT-97530HM-OT SESSION BY OT ASST                       2               5.000000          325.6000           65.1200
  OCCT-97530HMGT-OT SESSION BY OT ASST                     1               0.750000           48.8400           65.1200
  PHY-97110-PT SESSION BY LICENSED PT                      8              74.000000         6017.6800           81.3200
  PHY-97110GPGT-PT SESSION BY LICENSED PT                  1               1.000000           81.3200           81.3200
  PHY-97110GT-PT SESSION BY LICENSED PT                    3               3.000000          243.9600           81.3200
  PHY-97110HM-PT SESSION BY PT ASST                        5              33.250000         2018.7200           60.7134
  PHY-97110HMGT-PT SESSION BY PT ASST                      4              23.000000         1497.7600           65.1200
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP           15             103.500000         7945.7400           76.7704
  SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP         10              49.500000         3781.3800           76.3915
Subtotal (Total Children Is Unduplicated)               1018            12482.75000       457046.7700           36.6143
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Total                                                                  12575.750000       461592.3000           36.7050
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Number of Children (Unduplicated) With at Least One Service       1025
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Center 06
Flag      Claims          Units         Chgs         Paid
---------------------------------------------------------
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           4766    4818.000000  134308.9600  134308.9600 
D              0       0.000000       0.0000       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 
            7648    7757.750000  327283.3400       0.0000 
Other          0       0.000000       0.0000       0.0000 
---------------------------------------------------------
Total      12414   12575.750000  461592.3000  134308.9600