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
Payclass Filters:GR
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 1 2.000000 161.9600 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 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 13 33.000000 2350.5000 71.2273
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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 11 41.000000 2214.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 207 872.000000 13080.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 113 430.000000 5160.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 4.000000 325.2800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 10.000000 813.2000 81.3200
TRAV-TRAVS-Travel by mile 141 5994.000000 2666.4300 0.4448
Subtotal (Total Children Is Unduplicated) 317 7469.750000 30115.3700 4.0316
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Total 7502.750000 32465.8700 4.3272
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Number of Children (Unduplicated) With at Least One Service 328
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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 2008 7501.750000 32453.8700 32453.8700
1 1.000000 12.0000 12.0000
Other 0 0.000000 0.0000 0.0000
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Total 2009 7502.750000 32465.8700 32465.8700