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:TPIN
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 2 4.000000 323.9200 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 29 66.000000 4696.8400 71.1642
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 20 42.000000 3239.2000 77.1238
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 26.000000 1557.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 15.000000 813.5400 54.2360
Subtotal (Total Children Is Unduplicated) 51 161.000000 11091.1500 68.8891
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 316.250000 17077.5000 54.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 243.9600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 12 45.500000 3618.7400 79.5327
PHY-97110-PT SESSION BY LICENSED PT 10 22.000000 1789.0400 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
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 79.000000 5692.4000 72.0557
Subtotal (Total Children Is Unduplicated) 123 493.750000 30224.2800 61.2137
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Total 654.750000 41315.4300 63.1011
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Number of Children (Unduplicated) With at Least One Service 171
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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 441 476.500000 28164.3500 28164.3500
149 178.250000 13151.0800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 590 654.750000 41315.4300 28164.3500