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
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 125 70.250000 3209.0200 45.6800
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 40.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 281 347.250000 15862.3800 45.6800
Subtotal (Total Children Is Unduplicated) 371 457.500000 19071.4000 41.6861
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 239.6800 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 179.7600 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 11 17.500000 1048.6000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1133.7200 80.9800
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
Subtotal (Total Children Is Unduplicated) 29 54.500000 3774.3200 69.2536
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Total 512.000000 22845.7200 44.6205
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Number of Children (Unduplicated) With at Least One Service 380
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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
837 512.000000 22845.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 837 512.000000 22845.7200 0.0000