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:EIP DEI DEIP
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
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 18 32.000000 2591.3600 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 14 25.500000 2022.8700 79.3282
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 7 12.000000 971.7600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 20.500000 1660.0900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 46.000000 2756.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 39 73.500000 4404.1200 59.9200
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 1 4.000000 232.4400 58.1100
Subtotal (Total Children Is Unduplicated) 99 228.000000 15702.4400 68.8704
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 325.2800 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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 23.000000 1870.3600 81.3200
Subtotal (Total Children Is Unduplicated) 17 46.250000 3774.3900 81.6084
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Total 274.500000 19488.2500 70.9954
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Number of Children (Unduplicated) With at Least One Service 115
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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 72 112.250000 7929.6000 7929.6000
D 1 2.000000 161.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 35 55.000000 4034.9700 4034.9700
T 49 71.250000 4987.4800 4987.4800
18 32.000000 2254.4000 0.0000
Other 1 2.000000 119.8400 0.0000
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Total 176 274.500000 19488.2500 16952.0500