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
Payclass Filters:TPIN
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 8 14.750000 644.1000 43.6678
Subtotal (Total Children Is Unduplicated) 8 14.750000 644.1000 43.6678
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Screening, Eval, and Assessment,Class #02
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 1 1.000000 59.9200 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 6.000000 485.8800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 19.500000 1168.4400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 389.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 566.8600 70.8575
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
Subtotal (Total Children Is Unduplicated) 28 65.000000 4614.1000 70.9862
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 297.6000 74.4000
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 1 0.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 14.000000 378.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 89 306.000000 16524.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 13 23.500000 1269.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 33.000000 2683.5600 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 17 48.000000 3903.3600 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 2 4.000000 325.2800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 13 65.000000 4232.8000 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.500000 162.8000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 43 117.500000 9555.1000 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 3 2.000000 162.6400 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 145.000000 11791.4000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 243.9600 81.3200
Subtotal (Total Children Is Unduplicated) 204 771.000000 51773.4600 67.1511
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Total 850.750000 57031.6600 67.0369
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Number of Children (Unduplicated) With at Least One Service 221
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Center 54
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 1 0.860000 70.7200 70.7200
D 34 33.390000 2153.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 4 4.000000 325.2800 0.0000
T 133 133.810000 8497.4700 8497.4700
661 675.690000 45741.1900 0.0000
Other 3 3.000000 243.9600 0.0000
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Total 836 850.750000 57031.6600 8568.1900