CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 104 359.000000 13354.8000 37.2000
Subtotal (Total Children Is Unduplicated) 104 359.000000 13354.8000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 161.6400 80.8200
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.000000 179.7600 59.9200
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 202.4500 80.9800
Subtotal (Total Children Is Unduplicated) 5 7.500000 543.8500 72.5133
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Total 366.500000 13898.6500 37.9226
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Number of Children (Unduplicated) With at Least One Service 104
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Center 01
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 2.000000 161.6400 0.0000
S 84 74.250000 2762.1000 0.0000
H 351 280.500000 10612.2100 10612.2100
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 11 9.750000 362.7000 0.0000
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Total 447 366.500000 13898.6500 10612.2100