CMS/EIP Fiscal Report Center: 05
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 60 243.000000 9039.6000 37.2000
Subtotal (Total Children Is Unduplicated) 60 243.000000 9039.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 209.7200 59.9200
Subtotal (Total Children Is Unduplicated) 2 3.500000 209.7200 59.9200
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Total 246.500000 9249.3200 37.5226
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Number of Children (Unduplicated) With at Least One Service 60
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Center 05
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 228 197.250000 7337.7000 5952.0000
P 1 1.500000 89.8800 89.8800
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
38 36.750000 1412.5400 119.8400
Other 18 11.000000 409.2000 0.0000
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Total 285 246.500000 9249.3200 6161.7200