CMS/EIP Fiscal Report Center: 55
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 884 852.250000 37020.6600 43.4387
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 224 189.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1238 5537.250000 249430.3200 45.0459
Subtotal (Total Children Is Unduplicated) 1262 6579.000000 286450.9800 43.5402
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 52.000000 4210.9600 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024GOTS-F/U PSYCH 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 10 19.000000 1138.4800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 280 568.000000 45996.6400 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 17 34.000000 2753.3200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 214.000000 17329.7200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1943.5200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 77 154.000000 12470.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 96.000000 5752.3200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 719.0400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 17 17.000000 987.8700 58.1100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 697.3200 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 290.5500 58.1100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 232.4400 58.1100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 384 1239.000000 96499.0100 77.8846
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 56 55.000000 2750.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 6 6.000000 300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 47 32.250000 806.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 42.000000 2100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 25 61.000000 1525.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 56 55.000000 2750.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 5 5.000000 250.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 47 32.250000 806.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 332 1759.250000 94999.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 24 94.000000 5076.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 397 2180.000000 32700.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 299 1552.000000 18627.0000 12.0019
OCCT-97530-OT SESSION BY LICENSED OT 64 345.750000 28116.3900 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 87 574.750000 37427.7200 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 3 12.500000 814.0000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 42 199.000000 16182.6800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 38 212.250000 13838.0000 65.1967
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 208 1036.500000 84288.1800 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 28.000000 2276.9600 81.3200
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 14.000000 1138.4800 81.3200
Subtotal (Total Children Is Unduplicated) 737 8302.500000 347072.4100 41.8034
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Total 16120.500000 730022.4000 45.2853
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Number of Children (Unduplicated) With at Least One Service 1309
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Center 55
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 3082 3048.250000 154192.7900 0.0000
P 3292 3275.221955 103404.4900 103404.4900
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 1749 1741.956135 53438.1100 53438.1100
9045 8055.071910 418987.0100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17168 16120.500000 730022.4000 156842.6000