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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 688.3300 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 404.9000 80.9800
Subtotal (Total Children Is Unduplicated) 9 15.000000 1214.7000 80.9800
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 18.000000 972.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 51.000000 4147.3200 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 7 23.000000 1870.3600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 8.000000 650.5600 81.3200
Subtotal (Total Children Is Unduplicated) 29 105.000000 8046.8400 76.6366
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Total 120.000000 9261.5400 77.1795
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Number of Children (Unduplicated) With at Least One Service 37
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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 7 7.000000 514.6000 514.6000
107 113.000000 8746.9400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 114 120.000000 9261.5400 514.6000