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:MED
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1619.6000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 18 36.000000 2685.5600 74.5989
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 131 545.500000 29484.0000 54.0495
OCCT-97530TLGO-OT SESSION BY LICENSED OT 6 13.000000 1057.1600 81.3200
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-92507TL-SPL THERAPY SESSION BY LICENSED SLP 15 44.750000 3639.0700 81.3200
Subtotal (Total Children Is Unduplicated) 158 664.250000 38654.7500 58.1931
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Total 700.250000 41340.3100 59.0365
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Number of Children (Unduplicated) With at Least One Service 174
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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 0 0.000000 0.0000 0.0000
694 700.250000 41340.3100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 694 700.250000 41340.3100 0.0000