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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.250000 11.4200 45.6800
Subtotal (Total Children Is Unduplicated) 1 0.250000 11.4200 45.6800
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 35.500000 2874.7900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 29.500000 2346.7900 79.5522
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 23 43.500000 3522.6300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2429.4000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 36.000000 2915.2800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 90.000000 5392.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 65 124.500000 7460.0400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 24.000000 1356.8600 56.5358
Subtotal (Total Children Is Unduplicated) 130 433.500000 29694.5100 68.4994
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 13.000000 702.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 47 189.000000 15369.4800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 4 13.000000 1057.1600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 3.750000 345.6100 92.1627
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.500000 121.9800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 8 44.500000 2897.8400 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 4.000000 260.4800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 68 264.000000 21468.4800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 11.000000 716.3200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 520.500000 42251.3400 81.1745
Subtotal (Total Children Is Unduplicated) 200 1066.250000 85305.8100 80.0054
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Total 1500.000000 115011.7400 76.6745
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Number of Children (Unduplicated) With at Least One Service 312
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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 708 786.000000 60239.1300 60239.1300
D 8 9.000000 731.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 35 55.000000 4034.9700 4034.9700
T 445 454.500000 35058.6600 35058.6600
122 144.000000 11240.6300 0.0000
Other 26 51.500000 3707.1500 0.0000
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Total 1344 1500.000000 115011.7400 99332.7600