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: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 1 1.000000 45.6800 45.6800
Subtotal (Total Children Is Unduplicated) 1 1.000000 45.6800 45.6800
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 209.7200 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 3 4.500000 364.4100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 12.000000 971.7600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 11 17.000000 1345.0700 79.1218
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 43.500000 2606.5200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 43.500000 2606.5200 59.9200
Subtotal (Total Children Is Unduplicated) 64 125.500000 8225.4700 65.5416
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 265 1039.000000 56106.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 55 88.500000 4779.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 23.000000 1870.3600 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 1 6.000000 487.9200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 14.000000 1138.4800 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
Subtotal (Total Children Is Unduplicated) 302 1194.500000 66333.4400 55.5324
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Total 1321.000000 74604.5900 56.4758
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Number of Children (Unduplicated) With at Least One Service 347
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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 0 0.000000 0.0000 0.0000
1266 1321.000000 74604.5900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1266 1321.000000 74604.5900 0.0000