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
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 36 17.500000 748.5200 42.7726
TCM-T1017TL-TARGETED CASE MANAGEMENT 30 141.250000 6323.2600 44.7664
Subtotal (Total Children Is Unduplicated) 49 158.750000 7071.7800 44.5466
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 485.8800 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 359.5200 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 10 20.000000 1198.4000 59.9200
Subtotal (Total Children Is Unduplicated) 14 32.000000 2043.8000 63.8688
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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
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Total 203.750000 9120.9200 44.7653
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Number of Children (Unduplicated) With at Least One Service 50
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Center 52
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 0 0.000000 0.0000 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 4 18.000000 491.2200 421.2200
182 182.750000 8492.6600 0.0000
Other 3 3.000000 137.0400 0.0000
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Total 189 203.750000 9120.9200 421.2200