CMS/EIP Fiscal Report Center: 52
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 36 17.500000 748.5200 42.7726
TCM-T1017TL-TARGETED CASE MANAGEMENT 61 288.250000 13036.1000 45.2250
Subtotal (Total Children Is Unduplicated) 61 305.750000 13784.6200 45.0846
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 647.8400 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 479.3600 59.9200
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 36.000000 2915.2800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 24.000000 1619.6000 67.4833
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 33 66.000000 3945.8800 59.7861
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
Subtotal (Total Children Is Unduplicated) 44 160.000000 10981.3600 68.6335
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 2 1.000000 0.0000 0.0000
TRAV-TRAVS-Travel by mile 1 12.000000 5.3400 0.4450
Subtotal (Total Children Is Unduplicated) 2 13.000000 5.3400 0.4108
-----------------------------------------------------------------------------------------------------------------------
Total 478.750000 24771.3200 51.7417
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 61
-----------------------------------------------------------------------------------------------------------------------
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 51 80.250000 4231.8200 0.0000
P 44 71.750000 4187.2200 3967.7400
D 0 0.000000 0.0000 0.0000
S 41 37.500000 1710.8800 0.0000
H 2 4.000000 323.9200 0.0000
T 19 48.000000 2486.8600 2365.7000
211 234.250000 11693.5800 0.0000
Other 3 3.000000 137.0400 0.0000
---------------------------------------------------------
Total 371 478.750000 24771.3200 6333.4400