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
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 680 1946.000000 88602.5800 45.5306
Subtotal (Total Children Is Unduplicated) 680 1946.000000 88602.5800 45.5306
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 364.4100 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 269.6400 59.9200
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 13 23.000000 1862.5400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 40.000000 3197.0800 79.9270
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 44.000000 3563.1200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 43 83.500000 6761.8300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 16.000000 1295.6800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 22 42.000000 3401.1600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 83.000000 4973.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 85 162.000000 9707.0400 59.9200
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 137 510.500000 35947.1200 70.4155
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 710 3807.500000 205497.0000 53.9716
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 10.000000 540.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 40 204.000000 16589.2800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 16 70.000000 4623.2000 66.0457
OCCT-97530HMGT-OT SESSION BY OT ASST 1 3.000000 195.3600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 27 103.000000 8375.9600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 3 25.000000 1628.0000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 177.000000 14393.6400 81.3200
Subtotal (Total Children Is Unduplicated) 751 4399.500000 251842.4400 57.2434
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Total 6856.000000 376392.1400 54.8997
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Number of Children (Unduplicated) With at Least One Service 1015
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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 0 0.000000 0.0000 0.0000
D 11 11.000000 621.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 1079 1326.250000 66040.2000 66040.2000
T 0 0.000000 0.0000 0.0000
5237 5408.750000 302349.6700 0.0000
Other 57 110.000000 7380.9500 0.0000
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Total 6384 6856.000000 376392.1400 66040.2000