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:GR
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 2065.750000 94258.5600 45.6292
TCM-T1017TL-TARGETED CASE MANAGEMENT 766 2434.500000 110952.4800 45.5751
Subtotal (Total Children Is Unduplicated) 1394 4500.250000 205211.0400 45.5999
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 129 230.500000 11525.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 15.000000 1214.7000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 32.000000 2591.3600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 20.500000 1660.0900 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 15 27.000000 1617.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 26 49.000000 2936.0800 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) 233 586.000000 33512.3000 57.1882
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 161.750000 8087.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 6 8.500000 425.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 50 56.500000 1412.5000 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 20 25.000000 1250.0000 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 515 2314.500000 124767.0000 53.9067
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 4.000000 216.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 951 4932.000000 73935.0000 14.9909
INTR-T1013-INTERPRETER 58 236.000000 11600.0000 49.1525
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 459 2064.000000 24360.0000 11.8023
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 105 396.750000 32080.7400 80.8588
TRAV-TRAVS-Travel by mile 490 40220.00000 17890.7300 0.4448
Subtotal (Total Children Is Unduplicated) 1442 51218.75000 353283.0700 6.8975
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Total 56305.000000 592006.4100 10.5143
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Number of Children (Unduplicated) With at Least One Service 1990
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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 10674 35736.750000 331878.1000 331878.1000
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 4720 9633.250000 170706.3400 170706.3400
2677 10650.000000 82243.5700 11.4200
Other 16 32.000000 2212.2800 0.0000
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Total 18184 56305.000000 592006.4100 502595.8600