CMS/EIP Fiscal Report Center: 05
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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 72 36.750000 1657.5400 45.1031
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 56.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 101 409.000000 18683.1200 45.6800
Subtotal (Total Children Is Unduplicated) 102 501.750000 20340.6600 40.5394
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 28.500000 2307.9300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 931.2700 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 283.4300 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 526.3700 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.000000 599.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 24 42.500000 2546.6000 59.9200
Subtotal (Total Children Is Unduplicated) 39 118.000000 8323.6300 70.5392
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 108.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 17 20.000000 300.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 30 30.000000 360.0000 12.0000
TRAV-TRAVS-Travel by mile 60 1153.000000 512.9900 0.4449
Subtotal (Total Children Is Unduplicated) 62 1205.000000 1280.9900 1.0631
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Total 1824.750000 29945.2800 16.4106
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Number of Children (Unduplicated) With at Least One Service 102
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Center 05
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 297 230.750000 10540.6600 3768.2700
P 170 1237.000000 8891.8200 8891.8200
D 1 0.500000 22.8400 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
433 356.500000 10489.9600 712.8000
Other 0 0.000000 0.0000 0.0000
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Total 901 1824.750000 29945.2800 13372.8900