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
Agency Filter:EXT
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 1 1.000000 45.6800 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 2 2.000000 91.3600 45.6800
Subtotal (Total Children Is Unduplicated) 3 3.000000 137.0400 45.6800
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Screening, Eval, and Assessment,Class #02
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
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 526.3700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 22.500000 1822.0500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 22.000000 1749.9700 79.5441
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 53.000000 3175.7600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 35 64.500000 3864.8400 59.9200
Subtotal (Total Children Is Unduplicated) 91 178.500000 11694.3100 65.5143
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 124.3400 62.1700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.500000 125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 378 1507.000000 81378.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 71 111.500000 6021.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 280 1065.000000 15975.0000 15.0000
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 178 667.000000 8004.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 90.000000 7318.8000 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 14 32.000000 2602.2400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 6 11.000000 894.5200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.000000 243.9600 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 6.000000 487.9200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 24.000000 1951.6800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 243.9600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 243.9600 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 426 21532.00000 9578.4900 0.4448
Subtotal (Total Children Is Unduplicated) 471 25067.50000 135630.5100 5.4106
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Total 25249.000000 147461.8600 5.8403
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Number of Children (Unduplicated) With at Least One Service 511
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Center 53
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1131 7052.500000 19516.2700 19516.2700
4123 18196.500000 127945.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5254 25249.000000 147461.8600 19516.2700