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
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 503 220.500000 8221.2000 37.2844
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 173 154.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 459 1082.750000 40250.4000 37.1742
Subtotal (Total Children Is Unduplicated) 748 1458.000000 48471.6000 33.2453
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
Subtotal (Total Children Is Unduplicated) 1 2.000000 119.8400 59.9200
-----------------------------------------------------------------------------------------------------------------------
Total 1460.000000 48591.4400 33.2818
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 748
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1 2.000000 119.8400 119.8400
D 14 5.250000 195.3000 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
2956 1451.750000 48239.1000 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 2972 1460.000000 48591.4400 119.8400