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
Payclass Filters:GR
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 206 322.250000 14651.8600 45.4674
Subtotal (Total Children Is Unduplicated) 222 333.250000 15154.3400 45.4744
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 0.500000 25.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.000000 566.8600 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 647.8400 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 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 6 10.000000 599.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 449.4000 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 323.9200 80.9800
Subtotal (Total Children Is Unduplicated) 19 52.000000 3826.9200 73.5946
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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 4 3.500000 175.0000 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
OCCT-97530-OT SESSION BY LICENSED OT 4 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 31 36.750000 2100.7000 57.1619
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Total 422.000000 21081.9600 49.9573
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Number of Children (Unduplicated) With at Least One Service 265
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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 0 0.000000 0.0000 0.0000
H 1 1.000000 81.3200 0.0000
T 0 0.000000 0.0000 0.0000
571 421.000000 21000.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 572 422.000000 21081.9600 0.0000