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:TPIN
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 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
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
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 31 52.000000 4210.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 14.000000 1133.7200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 38.500000 3075.6100 79.8860
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 41 76.500000 6194.9700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 40.500000 3279.6900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 28 54.000000 4372.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 130.500000 7819.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 105 199.000000 11924.0800 59.9200
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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 24.000000 1356.8600 56.5358
Subtotal (Total Children Is Unduplicated) 194 642.000000 44156.9400 68.7803
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EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 13.000000 702.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 47 189.000000 15369.4800 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
OCCT-97530HM-OT SESSION BY OT ASST 9 50.500000 3288.5600 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 4.000000 260.4800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 68 264.000000 21468.4800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 11.000000 716.3200 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 109 522.500000 42413.9800 81.1751
Subtotal (Total Children Is Unduplicated) 201 1074.250000 85859.1700 79.9248
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Total 1716.500000 130027.5300 75.7515
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Number of Children (Unduplicated) With at Least One Service 377
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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 748 858.500000 65247.4000 65247.4000
D 8 9.000000 731.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 37 58.000000 4214.7300 4214.7300
T 481 514.000000 39160.9300 39160.9300
149 188.500000 14391.0600 0.0000
Other 46 88.500000 6282.2100 0.0000
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Total 1469 1716.500000 130027.5300 108623.0600