CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 69 114.000000 5207.5200 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 151 403.250000 18334.0200 45.4656
Subtotal (Total Children Is Unduplicated) 154 517.250000 23541.5400 45.5129
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 33.500000 2712.8300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 41 60.000000 4858.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 27.500000 2226.9500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 62 109.000000 8745.8400 80.2371
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 27.500000 2226.9500 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 39.000000 3158.2200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 90.000000 5392.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 124 209.000000 12463.3600 59.6333
Subtotal (Total Children Is Unduplicated) 181 604.500000 42378.9000 70.1057
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 15.000000 810.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 11 22.000000 330.0000 15.0000
INTR-T1013-INTERPRETER 6 12.250000 612.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 7.000000 84.0000 12.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 390.7200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 8 518.000000 230.5100 0.4450
Subtotal (Total Children Is Unduplicated) 19 584.250000 2783.0100 4.7634
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Total 1706.000000 68703.4500 40.2717
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Number of Children (Unduplicated) With at Least One Service 187
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Center 09
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 190 539.750000 12664.3600 12664.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 258 380.250000 22933.9200 8910.7300
T 176 247.500000 12620.6500 12620.6500
165 458.500000 15076.9200 0.0000
Other 43 80.000000 5407.6000 0.0000
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Total 832 1706.000000 68703.4500 34195.7400