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:MED
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 957 3533.750000 158100.6200 44.7402
Subtotal (Total Children Is Unduplicated) 957 3533.750000 158100.6200 44.7402
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Screening, Eval, and Assessment,Class #02
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 2 2.500000 202.4500 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 2 3.500000 283.4300 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 3 4.500000 269.6400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 57.000000 4615.8600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 60 76.000000 6154.4800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 32 36.500000 2955.7700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 67.500000 5466.1500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 29.000000 2327.3600 80.2538
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 24 33.000000 2672.3400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 61 76.000000 4574.9800 60.1971
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 48 70.000000 4194.4000 59.9200
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 182 466.000000 34468.7600 73.9673
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 508 3210.000000 172473.0000 53.7299
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 135 637.500000 34263.0000 53.7459
OCCT-97530-OT SESSION BY LICENSED OT 4 20.000000 1545.0800 77.2540
OCCT-97530GT-OT SESSION BY LICENSED OT 1 4.000000 162.6400 40.6600
PHY-97110-PT SESSION BY LICENSED PT 2 13.000000 1057.1600 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 10.000000 651.2000 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 6.000000 390.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 9.000000 731.8800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 603 3911.500000 211437.3200 54.0553
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Total 7911.250000 404006.7000 51.0674
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Number of Children (Unduplicated) With at Least One Service 1005
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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 0 0.000000 0.0000 0.0000
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
9310 7909.250000 403917.4600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9313 7911.250000 404006.7000 0.0000