CMS/EIP Fiscal Report Center: 10
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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1969 5879.250000 267201.1200 45.4482
Subtotal (Total Children Is Unduplicated) 1969 5879.250000 267201.1200 45.4482
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Screening, Eval, and Assessment,Class #02
AUDE-92558-OTOACOUSTIC EMISSIONS (SCREENING) 1 1.000000 6.8700 6.8700
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 34.500000 2793.8100 80.9800
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 0.500000 40.4900 80.9800
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 242.9400 80.9800
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 161.9600 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 14 27.500000 1647.8000 59.9200
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 445.3900 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 216 399.500000 32351.5100 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 15.500000 1255.1900 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 41 70.500000 5709.0900 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 485.8800 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 49 91.000000 7369.1800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 181 335.000000 20073.2000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 10 16.000000 958.7200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 72.000000 5830.5600 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 80.9800 80.9800
Subtotal (Total Children Is Unduplicated) 282 1082.500000 79615.5300 73.5478
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Total 6961.750000 346816.6500 49.8175
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Number of Children (Unduplicated) With at Least One Service 1971
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Center 10
Flag Claims Units Chgs Paid
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R 98 85.750000 3876.7800 0.0000
U 0 0.000000 0.0000 0.0000
B 6684 6084.500000 305973.1100 0.0000
P 22 38.500000 2713.8800 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
317 174.500000 7880.0000 0.0000
Other 793 578.500000 26372.8800 0.0000
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Total 7914 6961.750000 346816.6500 0.0000