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:MED
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 498 1330.000000 49476.0000 37.2000
Subtotal (Total Children Is Unduplicated) 498 1330.000000 49476.0000 37.2000
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Total 1330.000000 49476.0000 37.2000
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Number of Children (Unduplicated) With at Least One Service 498
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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 2226 1182.000000 43970.4000 32375.6600
P 0 0.000000 0.0000 0.0000
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
54 24.000000 892.8000 0.0000
Other 172 124.000000 4612.8000 0.0000
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Total 2452 1330.000000 49476.0000 32375.6600