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:GR
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 769 2101.500000 94571.4800 45.0019
Subtotal (Total Children Is Unduplicated) 1241 2763.000000 119258.1300 43.1626
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
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 3 4.000000 239.6800 59.9200
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 607.3500 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 4 8.000000 647.8400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 29.500000 2388.9100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 18.000000 1457.6400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 23.500000 1903.0300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 809.8000 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.500000 1827.5600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 69.000000 4134.4800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1295.6800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 38.000000 2969.2800 78.1389
Subtotal (Total Children Is Unduplicated) 118 291.000000 20632.2700 70.9013
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 15 40.000000 1686.9300 42.1733
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 1349.250000 30.0000 0.0222
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 54.0000 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 156 635.250000 34264.5000 53.9386
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 43 73.500000 3969.0000 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 20 57.000000 4635.2400 81.3200
OCCT-97530GO-OT SESSION BY LICENSED OT 26 101.000000 8213.3200 81.3200
OCCT-97530GOGT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 406.6000 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 8 18.500000 1204.7200 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 130.2400 65.1200
OCCT-97530TLGO-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530TLGOGT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 26 71.000000 5773.7200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 243.9600 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 50.000000 4066.0000 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 4.000000 325.2800 81.3200
TRAV-TRAVS-Travel by mile 712 39617.00000 17623.8600 0.4449
Subtotal (Total Children Is Unduplicated) 1118 46785.25000 167714.5100 3.5848
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Total 49839.250000 307604.9100 6.1719
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Number of Children (Unduplicated) With at Least One Service 1657
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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 78 69.750000 3627.3000 0.0000
S 54 23.000000 871.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 2017 14342.250000 36496.8000 36496.8000
12374 35386.500000 265729.6300 0.0000
Other 35 17.750000 879.3000 161.9600
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Total 14558 49839.250000 307604.9100 36658.7600