CMS/EIP Fiscal Report Center: 03
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 9 10.500000 479.6400 45.6800
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 4.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 37 62.750000 2866.4200 45.6800
Subtotal (Total Children Is Unduplicated) 43 77.250000 3346.0600 43.3147
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 728.8200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 9 16.500000 1336.1700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 15 26.500000 1587.8800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 647.8400 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
Subtotal (Total Children Is Unduplicated) 27 64.000000 4624.6300 72.2598
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
INTR-T1013-INTERPRETER 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 1 1.000000 75.0000 75.0000
-----------------------------------------------------------------------------------------------------------------------
Total 142.250000 8045.6900 56.5602
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 51
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
110 142.250000 8045.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 110 142.250000 8045.6900 0.0000