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
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 753 398.000000 17117.2800 43.0082
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 9 8.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 780 2643.000000 118269.4200 44.7482
Subtotal (Total Children Is Unduplicated) 1163 3049.000000 135386.7000 44.4036
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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-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 4.500000 364.4100 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 12.500000 1012.2500 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 27.000000 2186.4600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 16.500000 1336.1700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 16.500000 1336.1700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 3.000000 242.9400 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 11.500000 931.2700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 14.000000 838.8800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 21.000000 1258.3200 59.9200
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 148 225.500000 14478.8600 64.2078
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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 336 2020.250000 107118.5000 53.0224
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 90 377.250000 19075.5000 50.5646
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-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 7.000000 406.6000 58.0857
PHY-97110-PT SESSION BY LICENSED PT 1 7.000000 569.2400 81.3200
PHY-97110GPGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HMGT-PT SESSION BY PT ASST 1 6.000000 390.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 34.000000 2764.8800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 17.750000 1199.4700 67.5758
Subtotal (Total Children Is Unduplicated) 1082 8610.000000 242809.1200 28.2008
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Total 11884.500000 392674.6800 33.0409
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Number of Children (Unduplicated) With at Least One Service 1605
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Center 06
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 4665 4720.000000 127501.9400 127501.9400
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
9064 7064.250000 260646.3200 0.0000
Other 187 100.250000 4526.4200 0.0000
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Total 13916 11884.500000 392674.6800 127501.9400