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: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 733 575.000000 24686.6500 42.9333
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 101 86.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1645 5131.000000 230718.1600 44.9655
Subtotal (Total Children Is Unduplicated) 1713 5792.500000 255404.8100 44.0923
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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 5 10.000000 809.8000 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 485.8800 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 7 13.000000 778.9600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 15.500000 928.7600 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 6 11.500000 931.2700 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 14 27.000000 2186.4600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 15 36.000000 2915.2800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 58 111.000000 8988.7800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 29 57.500000 4656.3500 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 28 55.000000 4453.9000 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 26 53.000000 4291.9400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 85 156.000000 9347.5200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 84 171.500000 10276.2800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 44 88.000000 6937.3000 78.8330
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 108.000000 8637.8800 79.9804
SCREEN-T1023-SCREENING 1 1.000000 53.9800 53.9800
Subtotal (Total Children Is Unduplicated) 304 946.000000 68218.5500 72.1126
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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 440 1349.750000 30.0000 0.0222
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 682 2527.000000 38178.0000 15.1080
INTR-T1013-INTERPRETER 3 7.250000 475.8300 65.6317
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 462 1701.000000 20412.0000 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 712 39617.00000 17623.8600 0.4449
Subtotal (Total Children Is Unduplicated) 1133 50008.00000 369894.5200 7.3967
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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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Total 56746.500000 693517.8800 12.2213
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Number of Children (Unduplicated) With at Least One Service 1813
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Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 84 81.500000 4352.0200 0.0000
U 0 0.000000 0.0000 0.0000
B 2300 2196.750000 114038.8200 0.0000
P 1394 1315.610000 72120.9100 71325.9900
D 312 279.640000 14076.1400 6233.1400
S 183 134.000000 5827.8800 0.0000
H 8 7.750000 532.2200 0.0000
T 2152 14480.060000 45233.9500 45233.9500
14865 38023.940000 426590.3000 0.0000
Other 334 227.250000 10745.6400 1787.9000
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Total 21632 56746.500000 693517.8800 124580.9800