CMS/EIP Fiscal Report Center: 54
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 35 16.000000 669.4000 41.8375
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 16.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 47 315.750000 14194.5000 44.9549
Subtotal (Total Children Is Unduplicated) 78 348.250000 14863.9000 42.6817
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
IPDEF-T1024TSTLGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 283.4300 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 161.9600 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 323.9200 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1133.7200 80.9800
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 6.000000 485.8800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 479.3600 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 28.000000 1677.7600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 485.8800 80.9800
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 809.8000 80.9800
Subtotal (Total Children Is Unduplicated) 33 87.000000 6255.5100 71.9024
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE PERSONNEL TRAVEL 28 26.750000 0.0000 0.0000
EPIC-99601-Early Steps Professional Development Fee 32 39.000000 624.0000 16.0000
INTR-T1013-INTERPRETER 1 1.000000 36.6000 36.6000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9 12.000000 144.0000 12.0000
TRAV-TRAVS-Travel by mile 24 357.000000 158.7900 0.4448
Subtotal (Total Children Is Unduplicated) 46 435.750000 963.3900 2.2109
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Total 871.000000 22082.8000 25.3534
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Number of Children (Unduplicated) With at Least One Service 95
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Center 54
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 6 3.500000 159.8800 0.0000
S 7 5.500000 205.5600 0.0000
H 0 0.000000 0.0000 0.0000
T 34 170.000000 1336.7900 1336.7900
386 690.000000 20218.6100 0.0000
Other 1 2.000000 161.9600 161.9600
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Total 434 871.000000 22082.8000 1498.7500