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
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 125 70.250000 3209.0200 45.6800
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 40.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 600 920.750000 42059.8600 45.6800
Subtotal (Total Children Is Unduplicated) 640 1031.000000 45268.8800 43.9077
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 6.000000 359.5200 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 566.8600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 40.000000 2396.8000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 28.000000 2267.4400 80.9800
SCREEN-T1023-SCREENING 12 12.000000 647.7600 53.9800
Subtotal (Total Children Is Unduplicated) 58 107.000000 7161.5000 66.9299
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Total 1138.000000 52430.3800 46.0724
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Number of Children (Unduplicated) With at Least One Service 647
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Center 03
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 0 0.000000 0.0000 0.0000
1799 1138.000000 52430.3800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1799 1138.000000 52430.3800 0.0000