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
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 72 36.750000 1657.5400 45.1031
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 59 56.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 176.000000 8039.6800 45.6800
Subtotal (Total Children Is Unduplicated) 90 268.750000 9697.2200 36.0827
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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 3 4.500000 364.4100 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) 39 116.000000 8161.6700 70.3592
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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 1589.750000 19139.8800 12.0396
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Number of Children (Unduplicated) With at Least One Service 99
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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 0 0.000000 0.0000 0.0000
P 169 1235.000000 8729.8600 8729.8600
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
431 354.250000 10387.1800 712.8000
Other 0 0.000000 0.0000 0.0000
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Total 601 1589.750000 19139.8800 9442.6600