CMS/EIP Fiscal Report Center: 53
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 30 51.000000 2149.9600 42.1561
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 11.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 46 220.750000 9781.1200 44.3086
Subtotal (Total Children Is Unduplicated) 46 283.000000 11931.0800 42.1593
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 161.9600 80.9800
IPDEF-T1024TSTL-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 161.9600 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 35.500000 2874.7900 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 13.000000 1052.7400 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1133.7200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 10.000000 809.8000 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 9.000000 728.8200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.500000 202.4500 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 37.500000 2247.0000 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 11 18.500000 1108.5200 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.500000 364.4100 80.9800
Subtotal (Total Children Is Unduplicated) 48 148.500000 10846.1700 73.0382
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 30 30.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 5.000000 270.0000 54.0000
EPIC-99601-Early Steps Professional Development Fee 31 51.000000 765.0000 15.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 5 6.000000 72.0000 12.0000
TRAV-TRAVS-Travel by mile 10 216.000000 96.1000 0.4449
Subtotal (Total Children Is Unduplicated) 31 308.750000 1203.1000 3.8967
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Total 740.250000 23980.3500 32.3949
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Number of Children (Unduplicated) With at Least One Service 49
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Center 53
Flag Claims Units Chgs Paid
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R 2 2.250000 102.7800 0.0000
U 0 0.000000 0.0000 0.0000
B 107 138.250000 7979.5700 0.0000
P 36 50.250000 2523.4100 2489.4900
D 9 10.000000 520.8800 204.6000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 15 56.000000 691.8400 529.8800
328 474.500000 11666.0500 9.3000
Other 9 9.000000 495.8200 83.7000
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Total 506 740.250000 23980.3500 3316.9700