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:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 10.000000 540.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 6.000000 72.0000 12.0000
TRAV-TRAVS-Travel by mile 1 139.000000 61.8400 0.4449
Subtotal (Total Children Is Unduplicated) 3 157.000000 703.8400 4.4831
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Total 157.000000 703.8400 4.4831
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Number of Children (Unduplicated) With at Least One Service 3
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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 0 0.000000 0.0000 0.0000
24 157.000000 703.8400 517.8400
Other 0 0.000000 0.0000 0.0000
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Total 24 157.000000 703.8400 517.8400