CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 492 1112.750000 41394.3000 37.2000
Subtotal (Total Children Is Unduplicated) 492 1112.750000 41394.3000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 119.8400 59.9200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 19 34.000000 2037.2800 59.9200
SCREEN-T1023-SCREENING 3 3.000000 161.9400 53.9800
Subtotal (Total Children Is Unduplicated) 23 39.000000 2319.0600 59.4631
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Total 1151.750000 43713.3600 37.9539
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Number of Children (Unduplicated) With at Least One Service 493
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Center 03
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
1827 1151.750000 43713.3600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1827 1151.750000 43713.3600 0.0000