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
Payclass Filters:MED
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 16 30.500000 2469.8900 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 958.7200 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 27 54.500000 3900.7300 71.5730
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 752 5757.000000 310839.0000 53.9932
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 61.500000 3321.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 69.500000 5651.7400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 3 4.500000 293.0400 65.1200
PHY-97110HM-PT SESSION BY PT ASST 4 29.000000 1888.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 16.000000 1301.1200 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 8 37.000000 2409.4400 65.1200
Subtotal (Total Children Is Unduplicated) 772 5976.500000 325866.4600 54.5246
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Total 6031.000000 329767.1900 54.6787
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Number of Children (Unduplicated) With at Least One Service 782
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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 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 0 0.000000 0.0000 0.0000
6021 6031.000000 329767.1900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6021 6031.000000 329767.1900 0.0000