CMS/EIP Fiscal Report Center: 09
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 69 114.000000 5207.5200 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 54 172.250000 7845.5400 45.5474
Subtotal (Total Children Is Unduplicated) 84 286.250000 13053.0600 45.6002
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 607.3500 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 14.500000 1174.2100 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 607.3500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 23.000000 1378.1600 59.9200
Subtotal (Total Children Is Unduplicated) 22 60.000000 4270.3400 71.1723
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 10.000000 540.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 11 22.000000 330.0000 15.0000
INTR-T1013-INTERPRETER 6 12.250000 612.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 7.000000 84.0000 12.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
TRAV-TRAVS-Travel by mile 8 518.000000 230.5100 0.4450
Subtotal (Total Children Is Unduplicated) 19 571.250000 1959.6500 3.4305
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Total 917.500000 19283.0500 21.0169
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Number of Children (Unduplicated) With at Least One Service 100
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Center 09
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 145 457.750000 6886.7800 6886.7800
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 140 188.000000 8518.3800 8518.3800
49 257.750000 2954.7700 0.0000
Other 7 14.000000 923.1200 0.0000
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Total 341 917.500000 19283.0500 15405.1600