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
    Agency Filter:EXT       
    Payclass Filters:GR    
    Eligibility Filter:Part C (excluding not eligible)
 
 
Services                                              Number of            Number of    Fee Reported          Avg Fee
                                                      Children             Units                              Per/Unit
 
Screening, Eval, and Assessment,Class #02
  EXIT-EXIT-COS Exit                                      76             152.000000         7600.0000           50.0000
  IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS            1               2.000000          119.8400           59.9200
  IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT     3               5.500000          445.3900           80.9800
  IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT       7              13.500000         1093.2300           80.9800
  IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT         5               9.500000          769.3100           80.9800
  IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT       2               4.000000          323.9200           80.9800
  IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS       4               8.000000          479.3600           59.9200
  IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS     5              10.000000          599.2000           59.9200
  NUTR-97802-NUTRITIONAL EVAL, INITIAL                    22              73.000000         3650.0000           50.0000
  NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP                  13              47.000000         2350.0000           50.0000
  PSTH-97162-PT EVAL MODERATE COMPLEXITY                   1               1.000000           58.1100           58.1100
  SPCH-92521-EVAL OF SPEECH FLUENCY                        1               1.000000           58.1100           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            8              60.000000         3486.6000           58.1100
Subtotal (Total Children Is Unduplicated)                147             387.500000        21091.1800           54.4289
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EI Services,Class #03
  COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE            91             156.000000         7800.0000           50.0000
  COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE                49              53.500000         1337.5000           25.0000
  CONIF-CONIF-CONSULT, ITDS FACE TO FACE                   5               5.000000          250.0000           50.0000
  CONIP-CONIP-CONSULT, ITDS PHONE                          1               1.000000           25.0000           25.0000
  CONOF-CONOF-CONSULT, OT, FACE TO FACE                    2               2.000000           50.0000           25.0000
  CONOP-CONOP-CONSULT, OT, PHONE                           1               1.000000           25.0000           25.0000
  CONPF-CONPF-CONSULT, PT, FACE TO FACE                    9               9.000000          450.0000           50.0000
  CONSF-CONSF-CONSULT, SLP, FACE TO FACE                  19              24.000000         1200.0000           50.0000
  EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF          503            2284.500000       123147.0000           53.9054
  EPIC-99601-Early Steps Professional Development Fee    940            4910.000000        73605.0000           14.9908
  NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE             457            2057.000000        24276.0000           11.8017
  OCCT-97530-OT SESSION BY LICENSED OT                    68             248.000000        19760.7600           79.6805
  OCCT-97530GO-OT SESSION BY LICENSED OT                   2               8.250000          670.8900           81.3200
  OCCT-97530HM-OT SESSION BY OT ASST                      13              77.000000         4965.8300           64.4913
  OCCT-97530HMGT-OT SESSION BY OT ASST                     1               4.000000          260.4800           65.1200
  PHY-97110-PT SESSION BY LICENSED PT                     83             341.000000        27730.1200           81.3200
  PHY-97110HM-PT SESSION BY PT ASST                        7              46.000000         2995.5200           65.1200
  SPL-92507-SPL THERAPY SESSION BY LICENSED SLP          103             391.750000        31674.1400           80.8529
  TRAV-TRAVS-Travel by mile                              482            39702.00000        17660.2200            0.4448
Subtotal (Total Children Is Unduplicated)               1358            50321.00000       337883.4600            6.7146
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Total                                                                  50708.500000       358974.6400            7.0792
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Number of Children (Unduplicated) With at Least One Service       1402
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Center 09
Flag      Claims          Units         Chgs         Paid
---------------------------------------------------------
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           8482   33043.500000  223191.4200  223191.4200 
D             96     252.000000    4912.1200       0.0000 
S              1       1.000000      54.0000       0.0000 
H              0       0.000000       0.0000       0.0000 
T           2706    7522.000000   74235.1300   74235.1300 
            2083    9872.000000   55292.8100       0.0000 
Other          9      18.000000    1289.1600       0.0000 
---------------------------------------------------------
Total      13377   50708.500000  358974.6400  297426.5500