CMS/EIP Fiscal Report Center: 02
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
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-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-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 838.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1661.7200 75.5327
Subtotal (Total Children Is Unduplicated) 17 48.000000 3472.3600 72.3408
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EI Services,Class #03
TRAV-TRAVS-Travel by mile 24 889.000000 395.5600 0.4449
Subtotal (Total Children Is Unduplicated) 24 889.000000 395.5600 0.4449
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Total 937.000000 3867.9200 4.1280
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Number of Children (Unduplicated) With at Least One Service 31
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Center 02
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 0 0.000000 0.0000 0.0000
T 53 937.000000 3867.9200 3867.9200
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 53 937.000000 3867.9200 3867.9200