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
Payclass Filters:GR
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 1 2.000000 121.4700 60.7350
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 1 1.500000 80.9800 53.9867
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 6.500000 526.3700 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 9 17.000000 1092.5500 64.2676
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-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 14.000000 1133.7200 80.9800
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 40 98.500000 6614.4900 67.1522
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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 48 147.750000 7978.5000 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 55 211.750000 16358.3500 77.2531
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 37 135.750000 10652.9200 78.4745
PHY-97110GT-PT SESSION BY LICENSED PT 1 3.000000 222.6400 74.2133
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 78 335.750000 26544.3400 79.0598
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 650.5600 81.3200
Subtotal (Total Children Is Unduplicated) 350 2585.000000 89649.6400 34.6807
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Total 2683.500000 96264.1300 35.8726
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Number of Children (Unduplicated) With at Least One Service 381
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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 1695 2682.500000 96183.1500 96183.1500
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
1 1.000000 80.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1696 2683.500000 96264.1300 96183.1500