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
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 2082 6369.000000 289310.1600 45.4247
Subtotal (Total Children Is Unduplicated) 2082 6369.000000 289310.1600 45.4247
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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 243 443.000000 26544.5600 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 61 94.500000 7652.6100 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 202.4500 80.9800
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) 428 1613.500000 115968.0900 71.8736
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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 16551.500000 924098.3400 55.8317
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Number of Children (Unduplicated) With at Least One Service 2259
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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 7268 6881.250000 351539.2100 0.0000
P 29 48.250000 3431.4300 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
10281 8916.250000 536616.8300 0.0000
Other 802 586.500000 26738.3200 0.0000
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Total 18510 16551.500000 924098.3400 0.0000