CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 801 770.000000 33428.8400 43.4141
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 190 151.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 660 2419.250000 109009.5600 45.0592
Subtotal (Total Children Is Unduplicated) 1016 3340.750000 142438.4000 42.6367
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 64.000000 5182.7200 80.9800
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 323.9200 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 16.000000 1295.6800 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 239.6800 59.9200
Subtotal (Total Children Is Unduplicated) 40 92.000000 7365.9200 80.0643
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 12.000000 600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 85.000000 4590.0000 54.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 6.000000 487.9200 81.3200
Subtotal (Total Children Is Unduplicated) 30 118.000000 6327.9200 53.6264
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Total 3550.750000 156132.2400 43.9716
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Number of Children (Unduplicated) With at Least One Service 1017
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Center 55
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
4773 3550.750000 156132.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4773 3550.750000 156132.2400 0.0000