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
Agency Filter:EXT
Payclass Filters:GR
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-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 0.500000 29.9600 59.9200
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
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 3 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 647.8400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 21.500000 1288.2800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 23.000000 1378.1600 59.9200
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 20.000000 1619.6000 80.9800
Subtotal (Total Children Is Unduplicated) 41 87.000000 6055.4400 69.6028
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 38.000000 1538.1300 40.4771
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 17.750000 887.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 65 62.750000 3137.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 23 21.750000 1087.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 21 21.750000 1087.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 143 575.250000 31063.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 38 68.500000 3699.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 350 1381.000000 20715.0000 15.0000
INTR-T1013-INTERPRETER 2 6.250000 439.2300 70.2768
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 373 1379.000000 16548.0000 12.0000
OCCT-97530GO-OT SESSION BY LICENSED OT 2 9.000000 731.8800 81.3200
PHY-97110-PT SESSION BY LICENSED PT 12 27.000000 2195.6400 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 19.000000 1545.0800 81.3200
SPL-92507GT-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) 744 42892.00000 102378.1700 2.3869
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Total 42979.000000 108433.6100 2.5229
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Number of Children (Unduplicated) With at Least One Service 754
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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 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 1983 14172.250000 35160.0100 35160.0100
4328 28806.750000 73273.6000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6311 42979.000000 108433.6100 35160.0100