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
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 469 343.500000 15691.0800 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 1309 4771.750000 217973.5400 45.6800
Subtotal (Total Children Is Unduplicated) 1348 5115.250000 233664.6200 45.6800
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 5 9.250000 462.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 809.8000 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 35.500000 2874.7900 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 26 47.000000 2816.2400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 299.6000 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 185.500000 15021.7900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 228 397.500000 32189.5500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 9 15.000000 1214.7000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 22 35.500000 2874.7900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 324 587.500000 35203.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.500000 1048.6000 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) 394 1376.750000 96977.4400 70.4394
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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 1230 9514.000000 513717.0000 53.9959
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 85.500000 4617.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1007 7734.000000 116010.0000 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) 1281 23179.25000 698497.7300 30.1346
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Total 29671.250001 1029139.7900 34.6847
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Number of Children (Unduplicated) With at Least One Service 1874
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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 12 10.329440 797.1900 862.8700
D 147 141.250000 4314.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 2113 3458.250000 182473.6100 182473.6100
T 7262 9049.500000 189483.6100 189483.6100
15148 16882.670561 646166.4400 0.0000
Other 116 129.250000 5904.1400 0.0000
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Total 24798 29671.250001 1029139.7900 372820.0900