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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 612 333.250000 14433.2600 43.3106
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 788 2278.000000 102702.2600 45.0844
Subtotal (Total Children Is Unduplicated) 942 2611.750000 117135.5200 44.8494
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 26.000000 2105.4800 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1198.4000 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 112 232.000000 18139.5200 78.1876
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 106.000000 8421.9200 79.4521
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 64.000000 4858.8000 75.9188
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 136 274.000000 16349.3200 59.6691
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 1078.5600 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 116.2200 58.1100
SCREEN-T1023-SCREENING 13 13.000000 701.7400 53.9800
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 58.1100 58.1100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 15 46.000000 2420.2500 52.6141
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 11.000000 639.2100 58.1100
Subtotal (Total Children Is Unduplicated) 227 839.000000 57869.6300 68.9745
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 26.500000 1325.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 34 41.750000 2087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 22 15.750000 393.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 40 52.500000 2625.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 26.750000 1337.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 60.000000 3000.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 20 23.000000 1150.0000 50.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 148 191.750000 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 490 2153.500000 116313.0000 54.0111
EPIC-99601-Early Steps Professional Development Fee 412 1802.000000 27030.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 279 1233.000000 14796.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 53.000000 4087.3200 77.1192
OCCT-97530GO-OT SESSION BY LICENSED OT 17 68.500000 5266.4600 76.8826
OCCT-97530HM-OT SESSION BY OT ASST 7 25.000000 1530.8800 61.2352
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 18 44.000000 3578.0800 81.3200
OCCT-97530TLHM-OT SESSION BY OT ASST 5 16.000000 1041.9200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 29 101.500000 7384.6500 72.7552
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 8 30.500000 1986.1600 65.1200
PHY-97110TL-PT SESSION BY LICENSED PT 25 65.500000 5326.4600 81.3200
PHY-97110TLHM-PT SESSION BY PT ASST 8 37.000000 2409.4400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 157.000000 11295.3600 71.9450
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 27 82.750000 6729.2300 81.3200
TRAV-TRAVS-Travel by mile 348 24513.00000 10905.0600 0.4449
Subtotal (Total Children Is Unduplicated) 628 30830.25000 232211.5500 7.5319
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Total 34281.000000 407216.7000 11.8788
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Number of Children (Unduplicated) With at Least One Service 1061
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Center 52
Flag Claims Units Chgs Paid
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R 23 15.250000 746.5400 0.0000
U 0 0.000000 0.0000 0.0000
B 903 945.000000 49050.2400 0.0000
P 812 902.500000 51322.6900 49703.2000
D 25 25.750000 2092.6300 0.0000
S 218 197.500000 8940.3800 0.0000
H 64 70.750000 5519.3200 0.0000
T 5929 28761.000000 131521.5700 122371.9920
4053 3311.500000 155665.7500 566.9600
Other 66 51.750000 2357.5800 0.0000
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Total 12093 34281.000000 407216.7000 172642.1520