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:EIP DEI DEIP
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 1559.250000 70474.7000 45.1978
Subtotal (Total Children Is Unduplicated) 604 1559.250000 70474.7000 45.1978
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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 3 6.000000 359.5200 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 24 45.000000 3563.1200 79.1804
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 25 47.000000 3806.0600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 23.000000 1862.5400 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
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 17 29.500000 1758.8000 59.6203
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 838.8800 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) 120 292.000000 22036.6900 75.4681
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 254.500000 13743.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 21.000000 1134.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 162.6400 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 4 6.000000 487.9200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 1.250000 101.6500 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 59 258.750000 21041.5500 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 16 27.750000 2164.3200 77.9935
Subtotal (Total Children Is Unduplicated) 213 967.000000 71017.4700 73.4410
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Total 2818.250000 163528.8600 58.0250
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Number of Children (Unduplicated) With at Least One Service 663
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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
3 1.500000 104.1600 0.0000
Other 207 142.250000 6650.3700 349.1200
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Total 3086 2818.250000 163528.8600 57343.2900