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:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 576 315.750000 13684.7400 43.3404
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 330 933.250000 42199.1400 45.2174
Subtotal (Total Children Is Unduplicated) 727 1249.500000 55883.8800 44.7250
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
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 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 4134.4800 59.0640
SCREEN-T1023-SCREENING 2 2.000000 107.9600 53.9800
Subtotal (Total Children Is Unduplicated) 47 112.000000 7346.4400 65.5932
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 17.750000 887.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 21 22.250000 1112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 8.750000 218.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 29.750000 1487.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 2 2.500000 125.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 21.750000 1087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 13.500000 675.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 17.750000 887.5000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 146 190.750000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 125.750000 6790.5000 54.0000
EPIC-99601-Early Steps Professional Development Fee 236 928.000000 13920.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 171 796.000000 9552.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 7.000000 569.2400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 130.2400 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 15.000000 1219.8000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
TRAV-TRAVS-Travel by mile 225 18368.00000 8171.4500 0.4449
Subtotal (Total Children Is Unduplicated) 380 20577.00000 47565.1400 2.3116
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Total 21938.500000 110795.4600 5.0503
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Number of Children (Unduplicated) With at Least One Service 846
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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 3 1.500000 68.5200 0.0000
H 0 0.000000 0.0000 0.0000
T 2952 20227.750000 39787.5800 38275.5820
2701 1700.000000 70516.8200 37.1200
Other 11 9.250000 422.5400 0.0000
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Total 5667 21938.500000 110795.4600 38312.7020