CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
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 3 4.000000 148.8000 37.2000
Subtotal (Total Children Is Unduplicated) 3 4.000000 148.8000 37.2000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 9.000000 231.0000 25.6667
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 99.000000 5346.0000 54.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 4.000000 48.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 5.000000 406.6000 81.3200
Subtotal (Total Children Is Unduplicated) 16 117.000000 6031.6000 51.5521
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Total 121.000000 6180.4000 51.0777
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Number of Children (Unduplicated) With at Least One Service 19
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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 1 1.000000 54.0000 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
119 120.000000 6126.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 120 121.000000 6180.4000 0.0000