CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.750000 34.2600 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 86.500000 3951.3200 45.6800
Subtotal (Total Children Is Unduplicated) 30 87.250000 3985.5800 45.6800
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 209.7200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 50.500000 4089.4900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.000000 1457.6400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 17.000000 1376.6600 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 9.500000 769.3100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 9.500000 769.3100 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 364.4100 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 60.000000 3595.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 26.000000 1557.9200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.000000 1214.7000 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 9.500000 769.3100 80.9800
Subtotal (Total Children Is Unduplicated) 100 228.500000 16534.8200 72.3625
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EI Services,Class #03
INTR-T1013-INTERPRETER 29 50.000000 2509.5000 50.1900
TRAV-TRAVS-Travel by mile 12 240.000000 104.1000 0.4338
Subtotal (Total Children Is Unduplicated) 39 290.000000 2613.6000 9.0124
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Total 605.750000 23134.0000 38.1907
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Number of Children (Unduplicated) With at Least One Service 123
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Center 01
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 59 304.250000 3853.2400 3853.2400
D 6 9.000000 499.6000 0.0000
S 53 50.500000 2649.9100 0.0000
H 128 183.750000 12936.3500 8927.9700
T 8 12.750000 653.8900 657.3400
35 41.250000 2293.9200 0.0000
Other 3 4.250000 247.0900 0.0000
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Total 292 605.750000 23134.0000 13438.5500