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
Payclass Filters:GR
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 541 1992.250000 91005.9800 45.6800
Subtotal (Total Children Is Unduplicated) 793 2335.750000 106697.0600 45.6800
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 5 9.250000 462.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 445.3900 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 329.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 46.000000 3725.0800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 51.500000 4170.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 58 107.500000 6441.4000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 69 234.750000 16243.5100 69.1949
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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 33 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 39 39.000000 1950.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 470 3648.000000 196992.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 12 24.000000 1296.0000 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 5 24.500000 1992.3400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 19.500000 1585.7400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 130.2400 65.1200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 195.3600 65.1200
TRAV-TRAVS-Travel by mile 11 3280.000000 1459.5300 0.4450
Subtotal (Total Children Is Unduplicated) 1246 16724.75000 348099.3500 20.8134
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Total 19295.250000 471039.9200 24.4122
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Number of Children (Unduplicated) With at Least One Service 1634
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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 142 136.250000 3970.8400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7224 9011.500000 186872.6500 186872.6500
8436 10147.500000 280196.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15802 19295.250000 471039.9200 186872.6500