CMS/EIP Fiscal Report Center: 57
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 24 19.000000 867.9200 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 35 193.500000 8839.0800 45.6800
Subtotal (Total Children Is Unduplicated) 48 212.500000 9707.0000 45.6800
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 2.000000 100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 485.8800 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 10.500000 850.2900 80.9800
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 283.4300 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 20.500000 1228.3600 59.9200
Subtotal (Total Children Is Unduplicated) 14 42.500000 2947.9600 69.3638
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EI Services,Class #03
EPIC-99601-Early Steps Professional Development Fee 1 6.000000 90.0000 15.0000
Subtotal (Total Children Is Unduplicated) 1 6.000000 90.0000 15.0000
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Total 261.000000 12744.9600 48.8313
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Number of Children (Unduplicated) With at Least One Service 51
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Center 57
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 3 3.000000 45.0000 45.0000
153 258.000000 12699.9600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 156 261.000000 12744.9600 45.0000