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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 259 496.000000 22623.0200 45.6109
Subtotal (Total Children Is Unduplicated) 259 496.000000 22623.0200 45.6109
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Screening, Eval, and Assessment,Class #02
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-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 41 74.000000 5992.5200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 32.500000 2631.8500 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 14.500000 1174.2100 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 20 37.000000 2996.2600 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 21.500000 1741.0700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 16.500000 1336.1700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 76.000000 4553.9200 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 17.000000 1018.6400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1295.6800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 31.000000 2510.3800 80.9800
Subtotal (Total Children Is Unduplicated) 146 356.500000 26763.3700 75.0726
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 4.250000 229.5000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 5.000000 406.6000 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 162.6400 81.3200
PHY-97110-PT SESSION BY LICENSED PT 6 6.000000 487.9200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 5.000000 406.6000 81.3200
Subtotal (Total Children Is Unduplicated) 20 22.250000 1693.2600 76.1016
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Total 874.750000 51079.6500 58.3934
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Number of Children (Unduplicated) With at Least One Service 386
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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 624 660.750000 39794.9600 39794.9600
T 0 0.000000 0.0000 0.0000
6 5.000000 299.0000 0.0000
Other 4 1.000000 45.6800 0.0000
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Total 925 874.750000 51079.6500 39794.9600