CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Agency Filter:EXT
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 2 4.000000 239.6800 59.9200
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 36.500000 2955.7700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 20 39.500000 2366.8400 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 232.4400 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 52 97.000000 6550.1600 67.5274
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 4.750000 237.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 22.000000 1100.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 15 15.000000 750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 35 35.000000 1750.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 39 39.000000 1950.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 191.000000 5157.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1229 9508.000000 513393.0000 53.9959
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 85.500000 4617.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1006 7728.000000 115920.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 246 1872.000000 22488.0000 12.0128
OCCT-97530-OT SESSION BY LICENSED OT 28 151.500001 12319.9800 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 12 27.500000 1790.8000 65.1200
PHY-97110-PT SESSION BY LICENSED PT 15 49.500000 4025.3400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 4.000000 325.2800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 12 55.000000 3581.6000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 45.500000 3700.0600 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 81.3200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 13 50.000000 3256.0000 65.1200
TRAV-TRAVS-Travel by mile 11 3280.000000 1459.5300 0.4450
Subtotal (Total Children Is Unduplicated) 1280 23167.25000 698083.7300 30.1324
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Total 23264.250001 704633.8900 30.2883
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Number of Children (Unduplicated) With at Least One Service 1305
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Center 57
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 11 8.329440 677.3500 677.3500
D 147 141.250000 4314.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7259 9046.500000 189438.6100 189438.6100
12695 14068.170561 510203.1300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 20112 23264.250001 704633.8900 190115.9600