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:TPIN
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
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 928.7600 59.9200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 116.2200 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 174.3300 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 3 3.000000 174.3300 58.1100
Subtotal (Total Children Is Unduplicated) 18 29.500000 1833.7800 62.1620
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 85.000000 4590.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 51.000001 4147.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 3 12.000000 975.8400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 2 14.000000 911.6800 65.1200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 195.3600 65.1200
Subtotal (Total Children Is Unduplicated) 25 167.000001 10982.8400 65.7655
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Total 196.500001 12816.6200 65.2245
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Number of Children (Unduplicated) With at Least One Service 43
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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 3 3.000000 243.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 38 38.000000 2610.9600 2610.9600
151 147.170561 9284.3500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 203 196.500001 12816.6200 3288.3100