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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1096 2066.000000 94269.9800 45.6292
TCM-T1017TL-TARGETED CASE MANAGEMENT 1575 4732.000000 215471.6600 45.5350
Subtotal (Total Children Is Unduplicated) 1748 6798.000000 309741.6400 45.5636
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 144 260.500000 13025.0000 50.0000
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 3 5.000000 404.9000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 8.500000 688.3300 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 5 8.000000 479.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 15.500000 928.7600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 106.000000 8583.8800 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 93 147.500000 11902.4300 80.6944
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 74 131.500000 10606.7500 80.6597
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 173 315.500000 25468.2100 80.7233
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 90.500000 7328.6900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 66 127.000000 10284.4600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 187 325.000000 19474.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 334 594.000000 35532.5600 59.8191
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
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
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
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 2 2.000000 116.2200 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 14 86.000000 4959.6800 57.6707
Subtotal (Total Children Is Unduplicated) 735 2361.500000 157116.0200 66.5323
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 110 195.750000 9787.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 61 69.750000 1743.7500 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 5 5.000000 200.0000 40.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 36.000000 1800.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 42 55.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1269 6830.000000 368496.0000 53.9526
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 14.000000 756.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1065 7042.000000 105585.0000 14.9936
INTR-T1013-INTERPRETER 58 236.000000 11600.0000 49.1525
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 508 2589.000000 30660.0000 11.8424
OCCT-97530-OT SESSION BY LICENSED OT 141 728.000000 58794.3600 80.7615
OCCT-97530GO-OT SESSION BY LICENSED OT 6 21.250000 1728.0500 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 32 197.500000 12877.5900 65.2030
OCCT-97530HMGT-OT SESSION BY OT ASST 2 11.000000 716.3200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 186 994.000000 80832.0800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 12 86.000000 5600.3200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 267 1498.250000 121579.0000 81.1473
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 514 44738.00000 19900.5500 0.4448
Subtotal (Total Children Is Unduplicated) 1589 65385.75000 834864.5100 12.7683
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Total 74545.250000 1301722.1700 17.4622
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Number of Children (Unduplicated) With at Least One Service 2283
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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 13622 40549.250000 472085.1400 472085.1400
D 146 314.000000 7290.4200 0.0000
S 1 1.000000 54.0000 0.0000
H 1594 2102.000000 114109.6000 78985.9000
T 7533 14907.000000 282014.3700 282014.3700
8160 16412.500000 408383.7800 11.4200
Other 135 259.500000 17784.8600 0.0000
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Total 31191 74545.250000 1301722.1700 833096.8300