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
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 445 324.500000 14823.1600 45.6800
TCM-T1017TL-TARGETED CASE MANAGEMENT 506 1798.750000 82166.9000 45.6800
Subtotal (Total Children Is Unduplicated) 745 2123.250000 96990.0600 45.6800
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 4 7.250000 362.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 445.3900 80.9800
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 329.5600 59.9200
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 40.000000 3239.2000 80.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 24 41.000000 3320.1800 80.9800
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 121.4700 80.9800
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 79.000000 4733.6800 59.9200
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 89.8800 59.9200
Subtotal (Total Children Is Unduplicated) 53 181.250000 12641.8600 69.7482
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Total 2304.500000 109631.9200 47.5730
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Number of Children (Unduplicated) With at Least One Service 749
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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 0 0.000000 0.0000 0.0000
2143 2304.500000 109631.9200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2143 2304.500000 109631.9200 0.0000