CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
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 698 559.000000 24017.2500 42.9647
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 83 70.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1530 4418.500000 198750.4600 44.9814
Subtotal (Total Children Is Unduplicated) 1598 5047.500000 222767.7100 44.1343
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 116.8300 116.8300
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 659.1200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.000000 599.2000 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 4 8.000000 647.8400 80.9800
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 25.000000 2024.5000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 12 30.000000 2429.4000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 66.500000 5385.1700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 21 42.000000 3401.1600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 37.000000 2996.2600 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 33.000000 2672.3400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 62 116.000000 6950.7200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 110.000000 6591.2000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 68.000000 5425.6600 79.7891
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 70.500000 5601.1300 79.4487
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 213 664.000000 47785.6900 71.9664
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 47.9400 47.9400
ASST-ASST-ASSISTIVE TECHNOLOGY 17 44.000000 1984.5300 45.1030
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 36.500000 1775.0000 48.6301
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 137 141.750000 7091.5000 50.0282
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 29 26.750000 1337.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 123 61.750000 3133.0000 50.7368
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 3.750000 187.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 209 100.250000 5012.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 16 6.750000 168.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 1.500000 75.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 137 58.750000 2937.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 5.500000 275.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 165 65.250000 3262.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 412 1323.000000 30.0000 0.0227
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 38.000000 1026.0000 27.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 15.0000 15.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 648 2550.250000 137782.4600 54.0270
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 121 189.000000 10206.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 650 2488.000000 37554.0000 15.0941
INTR-T1013-INTERPRETER 2 6.250000 439.2300 70.2768
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 453 1689.000000 20268.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 38 94.000000 7644.0800 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 50 167.000000 13580.4400 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 5 9.000000 731.8800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 6.000000 487.9200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 21 84.500000 5502.6400 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 4 4.500000 293.0400 65.1200
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 60 200.000000 16264.0000 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 4 4.000000 325.2800 81.3200
OCCT-97530TLGTHM-OT SESSION BY OT ASST 6 9.000000 586.0800 65.1200
OCCT-97530TLHM-OT SESSION BY OT ASST 17 73.000000 4753.7600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 89 256.000000 20817.9200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 4 3.000000 243.9600 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 50 184.750000 15023.8700 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 2 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 105 305.500000 24843.2600 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 10 10.000000 813.2000 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 35 52.000000 4228.6400 81.3200
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 688 39260.00000 17465.0700 0.4449
Subtotal (Total Children Is Unduplicated) 1087 49572.25000 368931.1300 7.4423
-----------------------------------------------------------------------------------------------------------------------
CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 2
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 55283.750000 639484.5300 11.5673
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1698
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 79 73.250000 4100.7800 0.0000
U 0 0.000000 0.0000 0.0000
B 2087 1922.000000 100133.4600 0.0000
P 1266 1156.860000 63875.2700 63243.1900
D 298 267.390000 13516.5600 5907.6400
S 151 104.250000 4531.5400 0.0000
H 8 7.750000 532.2200 0.0000
T 2116 14306.060000 43657.4800 43657.4800
14424 37232.440000 399078.8600 0.0000
Other 325 213.750000 10058.3600 1226.0400
---------------------------------------------------------
Total 20754 55283.750000 639484.5300 114034.3500