CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1710 5608.750000 254726.1000 45.4158
Subtotal (Total Children Is Unduplicated) 1710 5608.750000 254726.1000 45.4158
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Screening, Eval, and Assessment,Class #02
AUDE-92558-OTOACOUSTIC EMISSIONS (SCREENING) 2 2.000000 13.7400 6.8700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 41.500000 3360.6700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 242.9400 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 15 29.500000 1767.6400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.500000 769.3100 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 296 532.000000 43081.3600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 13 21.000000 1700.5800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 55 92.500000 7490.6500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 8.500000 688.3300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 69 123.500000 10001.0300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 244 445.000000 26664.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 20.500000 1228.3600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 95.500000 7733.5900 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 202.4500 80.9800
Subtotal (Total Children Is Unduplicated) 380 1434.500000 105592.8900 73.6095
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Total 7043.250000 360318.9900 51.1581
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Number of Children (Unduplicated) With at Least One Service 1712
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Center 10
Flag Claims Units Chgs Paid
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R 117 107.750000 5010.4900 0.0000
U 0 0.000000 0.0000 0.0000
B 7274 6887.250000 351877.0700 0.0000
P 29 48.250000 3431.4300 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7420 7043.250000 360318.9900 0.0000