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
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 753 398.000000 17117.2800 43.0082
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 8.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1720 6205.750000 277814.0200 44.7672
Subtotal (Total Children Is Unduplicated) 1727 6611.750000 294931.3000 44.6071
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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 90 90.500000 4525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 283.4300 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 80.9800 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 10.500000 850.2900 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 2.500000 149.8000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 9.000000 539.2800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 91 109.500000 8867.3100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 112 142.500000 11539.6500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 65 73.000000 5911.5400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 85 120.000000 9717.6000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 43.000000 3461.0800 80.4902
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 42 52.500000 4251.4500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 99 123.000000 7391.2200 60.0912
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 84 121.500000 7280.2800 59.9200
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 434 917.500000 65838.0800 71.7581
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 58.250000 2912.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 325 357.250000 17737.5000 49.6501
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 17.250000 456.2500 26.4493
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 7.000000 350.0000 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 845 5348.250000 285944.7000 53.4651
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 32 153.000000 9517.0000 62.2026
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-97530GO-OT SESSION BY LICENSED OT 1 6.500000 528.5800 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
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 16 105.500000 8108.3800 76.8567
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 51.500000 3944.0200 76.5829
Subtotal (Total Children Is Unduplicated) 1157 12852.25000 476252.5900 37.0560
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Total 20381.500000 837021.9700 41.0677
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Number of Children (Unduplicated) With at Least One Service 1788
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Center 06
Flag Claims Units Chgs Paid
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R 3 2.000000 89.2400 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4767 4820.000000 134468.9600 134468.9600
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
18831 15459.250000 697937.3500 0.0000
Other 187 100.250000 4526.4200 0.0000
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Total 23788 20381.500000 837021.9700 134468.9600