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
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 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 54 116.000000 8745.8400 75.3952
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 58.000000 4534.8800 78.1876
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 34.000000 2429.4000 71.4529
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 66.000000 3945.8800 59.7861
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 359.5200 59.9200
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SCREEN-T1023-SCREENING 4 4.000000 215.9200 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
Subtotal (Total Children Is Unduplicated) 93 344.000000 23600.8500 68.6071
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 180 749.000000 40456.5000 54.0140
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 12.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 44.000000 3355.4400 76.2600
OCCT-97530GO-OT SESSION BY LICENSED OT 16 64.500000 4941.1800 76.6074
OCCT-97530HM-OT SESSION BY OT ASST 6 23.000000 1400.6400 60.8974
PHY-97110-PT SESSION BY LICENSED PT 25 84.500000 6002.2100 71.0321
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 6 27.000000 1758.2400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 146.000000 10400.8400 71.2386
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 243 1144.000000 68733.6500 60.0819
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Total 1488.000000 92334.5000 62.0528
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Number of Children (Unduplicated) With at Least One Service 309
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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 57 59.250000 3491.0400 2185.9500
D 25 25.750000 2092.6300 0.0000
S 0 0.000000 0.0000 0.0000
H 64 70.750000 5519.3200 0.0000
T 964 1012.500000 58734.9000 51206.3200
253 319.750000 22496.6100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1363 1488.000000 92334.5000 53392.2700