CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
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 1010 1339.750000 57551.4800 42.9569
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 61 47.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1058 2582.250000 114845.2400 44.4749
Subtotal (Total Children Is Unduplicated) 1268 3969.250000 172396.7200 43.4331
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 233.6600 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 4.000000 194.0000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.9200 7.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 49.5900 49.5900
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 15.1900 15.1900
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.000000 838.8800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 179.7600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 86.000000 6883.3000 80.0384
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 64.500000 5142.2300 79.7245
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 52.000000 4210.9600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 33.500000 2681.2400 80.0370
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 69.500000 5628.1100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 8 13.500000 1093.2300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 138.000000 8260.1200 59.8559
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 48 86.500000 5183.0800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 26.500000 2145.9700 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 607.3500 80.9800
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 11.000000 639.2100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 23.000000 1336.5300 58.1100
Subtotal (Total Children Is Unduplicated) 214 671.500000 47976.2300 71.4464
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 6.000000 421.9400 70.3233
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 8.250000 412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 14 8.750000 437.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.500000 275.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 109 70.000000 3500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 34 21.000000 1050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 9.000000 450.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 150 90.250000 4512.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 20 7.750000 193.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 8.500000 412.5000 48.5294
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 143 108.250000 5412.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.750000 43.7500 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 429 1170.500000 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 477 1862.000000 100548.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 93 145.500000 7857.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 634 2738.000000 41085.0000 15.0055
INTR-T1013-INTERPRETER 2 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 221 754.000000 9048.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 54 120.750000 9819.3900 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 26 90.000000 7318.8000 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 6 11.000000 894.5200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.000000 406.6000 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 3 8.000000 650.5600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 50 172.250000 14007.3700 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 13 12.500000 1016.5000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 47 206.000000 16910.6000 82.0903
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.500000 203.3000 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 48 209.500000 17036.5400 81.3200
PHY-97110TLGP-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110TLGPGT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 40.6600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 300.000000 24407.8000 81.3593
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 39.500000 3212.1400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 62 264.750000 21529.4700 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 17 29.750000 2326.9600 78.2171
TRAV-TRAVS-Travel by mile 426 21532.00000 9578.4900 0.4448
Subtotal (Total Children Is Unduplicated) 856 30029.00000 305507.2800 10.1737
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Total 34669.750000 525880.2300 15.1683
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Number of Children (Unduplicated) With at Least One Service 1437
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Center 53
Flag Claims Units Chgs Paid
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R 139 117.750000 6258.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 1607 1517.500000 88786.5600 37.2000
P 975 899.990000 54652.9400 54133.7400
D 297 273.510000 16668.0800 3640.0400
S 54 52.250000 3636.5000 0.0000
H 92 93.750000 7487.7300 0.0000
T 1145 7066.750000 20651.1900 19516.2700
13035 24488.500000 319919.3900 120.9000
Other 235 159.750000 7819.3200 349.1200
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Total 17579 34669.750000 525880.2300 77797.2700