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
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 163 62.000000 2306.4000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1169 2498.500000 93864.9000 37.5685
Subtotal (Total Children Is Unduplicated) 1260 2560.500000 96171.3000 37.5596
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 1.000000 50.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 2.000000 30.0000 15.0000
Subtotal (Total Children Is Unduplicated) 3 4.000000 130.0000 32.5000
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Total 2564.500000 96301.3000 37.5517
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Number of Children (Unduplicated) With at Least One Service 1261
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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 0 0.000000 0.0000 0.0000
S 2 1.500000 55.8000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 30.0000 30.0000
3943 2561.000000 96215.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3947 2564.500000 96301.3000 30.0000