CMS/EIP Fiscal Report Center: 51
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 364.4100 72.8820
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 5.000000 242.9400 48.5880
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.000000 566.8600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 15 28.000000 1677.7600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.500000 389.4800 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 202.4500 67.4833
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 20.000000 1619.6000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.000000 1254.5100 66.0268
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 162.6400 81.3200
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 283.4300 70.8575
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 59.9200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 22.500000 1822.0500 80.9800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 55 129.000000 9040.4500 70.0810
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1238.7800 1238.7800
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 54.0000 54.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 130 475.750000 25690.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 10.000000 563.6800 56.3680
EPIC-99601-Early Steps Professional Development Fee 68 375.000000 5625.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 286 1290.000000 15675.0000 12.1512
OCCT-97530-OT SESSION BY LICENSED OT 88 303.750000 23839.7900 78.4849
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 11.000000 809.1600 73.5600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 276.6800 69.1700
OCCT-97530HM-OT SESSION BY OT ASST 14 50.000000 2975.0300 59.5006
PHY-97110-PT SESSION BY LICENSED PT 53 194.000000 15389.8100 79.3289
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 222.6400 74.2133
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 110 461.500000 36770.3300 79.6757
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 10.000000 813.2000 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
Subtotal (Total Children Is Unduplicated) 351 3192.000000 130049.9200 40.7425
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Total 3321.000000 139090.3700 41.8821
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Number of Children (Unduplicated) With at Least One Service 389
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Center 51
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 1702 2689.500000 96561.1500 96561.1500
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
624 631.500000 42529.2200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2326 3321.000000 139090.3700 96561.1500