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
Payclass Filters:GR
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 9 24.000000 1096.3200 45.6800
Subtotal (Total Children Is Unduplicated) 10 24.750000 1130.5800 45.6800
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 6.500000 389.4800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 7 17.500000 1238.1400 70.7509
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EI Services,Class #03
INTR-T1013-INTERPRETER 29 49.000000 2459.5000 50.1939
TRAV-TRAVS-Travel by mile 12 240.000000 104.1000 0.4338
Subtotal (Total Children Is Unduplicated) 39 289.000000 2563.6000 8.8706
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Total 331.250000 4932.3200 14.8900
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Number of Children (Unduplicated) With at Least One Service 51
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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 43 278.750000 2135.1300 2135.1300
D 3 4.000000 200.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 10.750000 534.0500 537.5000
32 37.750000 2063.1400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 85 331.250000 4932.3200 2672.6300