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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 23 11.000000 502.4800 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 463 818.250000 37274.8800 45.5544
Subtotal (Total Children Is Unduplicated) 469 829.250000 37777.3600 45.5561
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 2 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 6.500000 526.3700 80.9800
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 419.4400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 404.9000 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 65 116.500000 9434.1700 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 27 49.500000 4008.5100 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 28.500000 2307.9300 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 30 56.500000 4575.3700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 35.500000 2874.7900 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.000000 1862.5400 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 75 129.000000 7729.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 38.500000 2306.9200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 29.500000 2388.9100 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 50.500000 4089.4900 80.9800
Subtotal (Total Children Is Unduplicated) 235 580.500000 43260.8200 74.5234
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 5.750000 287.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 5 4.750000 237.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 7.500000 375.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 6 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 5.500000 297.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.250000 67.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 12 18.000000 1463.7600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.000000 406.6000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 9 9.000000 731.8800 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 7.000000 569.2400 81.3200
Subtotal (Total Children Is Unduplicated) 52 73.750000 4885.9800 66.2506
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Total 1483.500000 85924.1600 57.9199
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Number of Children (Unduplicated) With at Least One Service 684
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 291 208.000000 10940.0100 0.0000
H 725 830.000000 52385.9100 39794.9600
T 0 0.000000 0.0000 0.0000
589 444.500000 22552.5600 0.0000
Other 4 1.000000 45.6800 0.0000
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Total 1609 1483.500000 85924.1600 39794.9600