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
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1040 1390.750000 59701.4400 42.9275
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 77 58.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1104 2803.000000 124626.3600 44.4618
Subtotal (Total Children Is Unduplicated) 1314 4252.250000 184327.8000 43.3483
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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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 4.000000 194.0000 48.5000
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
EXIT-EXIT-COS Exit 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.000000 838.8800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 179.7600 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 67 121.500000 9758.0900 80.3135
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 43 77.500000 6194.9700 79.9351
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 37 66.000000 5344.6800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 26 43.500000 3491.0400 80.2538
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 47 78.500000 6356.9300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 10 16.000000 1295.6800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 175.500000 10507.1200 59.8696
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 59 105.000000 6291.6000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 17 31.000000 2510.3800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 607.3500 80.9800
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 3 11.000000 639.2100 58.1100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 23.000000 1336.5300 58.1100
Subtotal (Total Children Is Unduplicated) 262 820.000000 58822.4000 71.7346
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 6.000000 421.9400 70.3233
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 8.250000 412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 14 8.750000 437.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 5.500000 275.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 109 70.000000 3500.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 34 21.000000 1050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 9.000000 450.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 150 90.250000 4512.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 20 7.750000 193.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 8.500000 412.5000 48.5294
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 143 108.250000 5412.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.750000 43.7500 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 459 1201.250000 0.0000 0.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 478 1867.000000 100818.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 93 145.500000 7857.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 665 2789.000000 41850.0000 15.0054
INTR-T1013-INTERPRETER 2 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 226 760.000000 9120.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 54 120.750000 9819.3900 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 26 90.000000 7318.8000 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 6 11.000000 894.5200 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.000000 406.6000 81.3200
OCCT-97530TL-OT SESSION BY LICENSED OT 3 8.000000 650.5600 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 50 172.250000 14007.3700 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 13 12.500000 1016.5000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 47 206.000000 16910.6000 82.0903
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.500000 203.3000 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 48 209.500000 17036.5400 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 71 300.000000 24407.8000 81.3593
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 20 39.500000 3212.1400 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 62 264.750000 21529.4700 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 17 29.750000 2326.9600 78.2171
TRAV-TRAVS-Travel by mile 436 21748.00000 9674.5900 0.4448
Subtotal (Total Children Is Unduplicated) 887 30337.75000 306710.3800 10.1099
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CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 2
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 35410.000000 549860.5800 15.5284
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Number of Children (Unduplicated) With at Least One Service 1486
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Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 141 120.000000 6361.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 1714 1655.750000 96766.1300 37.2000
P 1011 950.240000 57176.3500 56623.2300
D 306 283.510000 17188.9600 3844.6400
S 54 52.250000 3636.5000 0.0000
H 92 93.750000 7487.7300 0.0000
T 1160 7122.750000 21343.0300 20046.1500
13363 24963.000000 331585.4400 130.2000
Other 244 168.750000 8315.1400 432.8200
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Total 18085 35410.000000 549860.5800 81114.2400