CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
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 6.000000 485.8800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 96.000000 7126.2400 74.2317
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 52.000000 4049.0000 77.8654
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2276.9600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 6 6.000000 323.8800 53.9800
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 15.000000 813.5400 54.2360
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 79 230.000000 16127.2100 70.1183
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 8.750000 437.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 19 19.500000 975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.000000 175.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 19 22.750000 1137.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 46.500000 2325.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.250000 262.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 223 906.750000 48991.5000 54.0298
EPIC-99601-Early Steps Professional Development Fee 207 874.000000 13110.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 113 431.000000 5172.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 13 49.500000 3944.0200 79.6772
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 13.000000 1057.1600 81.3200
PHY-97110-PT SESSION BY LICENSED PT 10 24.000000 1951.6800 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 5 25.000000 1628.0000 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 11 31.000000 2520.9200 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 6 30.000000 1953.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 89.000000 6505.6000 73.0966
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 15 44.750000 3639.0700 81.3200
TRAV-TRAVS-Travel by mile 141 5994.000000 2666.4300 0.4448
Subtotal (Total Children Is Unduplicated) 317 8633.750000 99240.4000 11.4945
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Total 8863.750000 115367.6100 13.0157
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Number of Children (Unduplicated) With at Least One Service 373
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Center 52
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 0 0.000000 0.0000 0.0000
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 2449 7978.250000 60618.2200 60618.2200
850 885.500000 54749.3900 150.0000
Other 0 0.000000 0.0000 0.0000
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Total 3299 8863.750000 115367.6100 60768.2200