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: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 2 2.500000 114.2000 45.6800
Subtotal (Total Children Is Unduplicated) 2 2.500000 114.2000 45.6800
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 727.1900 76.5463
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1943.5200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 66.000000 5344.6800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 17.500000 1417.1500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 38.500000 2306.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 62.500000 3745.0000 59.9200
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 102 231.000000 16514.3300 71.4906
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 692 3754.500000 202635.0000 53.9712
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) 731 4336.500000 248440.4400 57.2905
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Total 4570.000000 265068.9700 58.0020
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Number of Children (Unduplicated) With at Least One Service 800
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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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4391 4449.000000 257066.7000 0.0000
Other 57 110.000000 7380.9500 0.0000
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Total 4459 4570.000000 265068.9700 0.0000