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:MED
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 2 2.750000 125.6200 45.6800
Subtotal (Total Children Is Unduplicated) 2 2.750000 125.6200 45.6800
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Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 581.1000 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 464.8800 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 13 13.000000 755.4300 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 13.000000 755.4300 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 21 137.000000 7961.0700 58.1100
Subtotal (Total Children Is Unduplicated) 52 182.000000 10576.0200 58.1100
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 765 5654.250000 305329.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 192 720.250000 38893.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 108 536.500000 43628.1800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 21 77.000000 5014.2400 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 165 640.500000 52085.4600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 25 101.250000 6593.4000 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 4.000000 260.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 760.750000 61864.1900 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 15.500000 1260.4600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 54.000000 3516.4800 65.1200
Subtotal (Total Children Is Unduplicated) 1124 8569.000000 518820.0900 60.5462
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Total 8753.750000 529521.7300 60.4908
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Number of Children (Unduplicated) With at Least One Service 1127
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Center 10
Flag Claims Units Chgs Paid
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R 1 0.750000 34.2600 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 13 11.500000 762.0600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9963 8741.500000 528725.4100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9977 8753.750000 529521.7300 0.0000