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
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 30 51.000000 2149.9600 42.1561
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 16 11.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16 80.750000 3472.3600 43.0014
Subtotal (Total Children Is Unduplicated) 40 143.000000 5622.3200 39.3169
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 404.9000 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 283.4300 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 80.9800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 11.500000 689.0800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 4.000000 239.6800 59.9200
Subtotal (Total Children Is Unduplicated) 11 30.000000 2102.9700 70.0990
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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 481.750000 8928.3900 18.5332
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Number of Children (Unduplicated) With at Least One Service 44
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Center 53
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 15 56.000000 691.8400 529.8800
298 424.750000 8155.5700 9.3000
Other 1 1.000000 80.9800 0.0000
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Total 314 481.750000 8928.3900 539.1800