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
Agency Filter:EXT
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 3.250000 148.4600 45.6800
Subtotal (Total Children Is Unduplicated) 1 3.250000 148.4600 45.6800
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 11 11.000000 236.0600 21.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 12 12.000000 193.8000 16.1500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 12.000000 95.0400 7.9200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 12.000000 381.7200 31.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 11 11.000000 254.5400 23.1400
EXIT-EXIT-COS Exit 101 102.000000 5100.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 10 77.000000 4474.4700 58.1100
Subtotal (Total Children Is Unduplicated) 124 240.000000 10909.9600 45.4582
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 5.000000 499.7300 99.9460
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 33.500000 1675.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 119 87.250000 4362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 31 39.000000 1950.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 136 215.000000 10750.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 12.000000 600.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 24 41.000000 2050.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 7 8.500000 425.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 117 188.500000 9425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 451 3002.500000 162135.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 112 374.000000 20196.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 617 4342.000000 65145.0000 15.0035
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 986 8107.000000 97274.3500 11.9988
OCCT-97530-OT SESSION BY LICENSED OT 23 99.750000 8061.6700 80.8187
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 7 21.500000 1400.0800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 43 192.250000 15633.7700 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 9.000000 586.0800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 54 277.750000 22586.6300 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 2 12.000000 781.4400 65.1200
Subtotal (Total Children Is Unduplicated) 1563 17082.25000 426321.8000 24.9570
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Total 17325.500000 437380.2200 25.2449
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Number of Children (Unduplicated) With at Least One Service 1569
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Center 10
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 17674 17299.000000 436494.6200 436494.6200
D 2 2.000000 162.6400 0.0000
S 20 19.500000 519.0000 200.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4 5.000000 203.9600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17700 17325.500000 437380.2200 436694.6200