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
Payclass Filters:GR
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 1 1.000000 45.6800 45.6800
Subtotal (Total Children Is Unduplicated) 2 2.000000 91.3600 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-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 0.500000 29.9600 59.9200
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 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 569.2400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.000000 1258.3200 59.9200
Subtotal (Total Children Is Unduplicated) 19 38.000000 2254.1400 59.3195
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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 117 450.000000 24300.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 16 23.000000 1242.0000 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 5 16.000000 1301.1200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
SPL-92507-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) 457 23768.00000 61250.2300 2.5770
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Total 23808.000000 63595.7300 2.6712
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Number of Children (Unduplicated) With at Least One Service 469
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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 1124 7045.500000 19001.6700 19001.6700
2750 16762.500000 44594.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3874 23808.000000 63595.7300 19001.6700