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
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 604 1560.250000 70520.3800 45.1981
Subtotal (Total Children Is Unduplicated) 604 1560.250000 70520.3800 45.1981
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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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 9.500000 769.3100 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.500000 569.2400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 46.500000 3684.5900 79.2385
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 28 51.500000 4170.4700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 35.000000 2834.3000 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 13 21.000000 1668.9900 79.4757
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 40.500000 3279.6900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 10.000000 809.8000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 73.000000 4365.3200 59.7989
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 32 57.500000 3445.4000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.500000 1660.0900 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 58.1100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 23.000000 1336.5300 58.1100
Subtotal (Total Children Is Unduplicated) 133 417.500000 30262.1600 72.4842
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 334 1293.500000 69849.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 68 109.500000 5913.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 25.000000 2033.0000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 6 8.000000 650.5600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 3 8.000000 650.5600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 50 170.250000 13844.7300 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 13 12.500000 1016.5000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 2 2.000000 162.6400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 47 205.500000 16711.2600 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 10 20.000000 1626.4000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.250000 345.6100 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 61 261.750000 21285.5100 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 17 29.750000 2326.9600 78.2171
Subtotal (Total Children Is Unduplicated) 489 2161.500000 137350.9100 63.5443
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Total 4139.250000 238133.4500 57.5306
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Number of Children (Unduplicated) With at Least One Service 774
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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 961 890.750000 53740.1300 53316.9300
D 123 104.000000 4905.4900 3640.0400
S 42 40.250000 2818.2100 0.0000
H 4 4.250000 265.4200 0.0000
T 0 0.000000 0.0000 0.0000
1269 1322.500000 74708.7500 0.0000
Other 207 142.250000 6650.3700 349.1200
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Total 4352 4139.250000 238133.4500 57343.2900