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:OTHER
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 132 196.000000 8813.3600 44.9661
Subtotal (Total Children Is Unduplicated) 132 196.000000 8813.3600 44.9661
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 14 28.000000 1400.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 6.500000 526.3700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 89.8800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 389.4800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 24.000000 1943.5200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 47 65.500000 5304.1900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 38.000000 3077.2400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 89.000000 7207.2200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 62.000000 3715.0400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 84 123.000000 7370.1600 59.9200
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 2.000000 116.2200 58.1100
Subtotal (Total Children Is Unduplicated) 163 447.500000 31260.7900 69.8565
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 34.000000 1700.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 13.250000 331.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 174 690.000000 37260.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 427 2110.000000 31650.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 125 525.000000 6300.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 87.000000 7074.8400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 60 286.000000 23257.5200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 260.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 402.000000 32690.6400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 93 4518.000000 2009.8200 0.4448
Subtotal (Total Children Is Unduplicated) 556 8688.250000 143609.8300 16.5292
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Total 9331.750000 183683.9800 19.6838
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Number of Children (Unduplicated) With at Least One Service 705
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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 2200 3954.000000 74959.6400 74959.6400
D 31 42.000000 1025.7800 0.0000
S 0 0.000000 0.0000 0.0000
H 384 567.000000 35123.7000 0.0000
T 2332 4759.750000 72147.1000 72147.1000
8 9.000000 427.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4955 9331.750000 183683.9800 147106.7400