CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
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 3 4.500000 167.4000 37.2000
Subtotal (Total Children Is Unduplicated) 3 4.500000 167.4000 37.2000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 5.000000 135.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 68.000000 3672.0000 54.0000
Subtotal (Total Children Is Unduplicated) 20 73.000000 3807.0000 52.1507
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Total 77.500000 3974.4000 51.2826
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Number of Children (Unduplicated) With at Least One Service 23
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Center 57
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 1.000000 54.0000 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
76 76.500000 3920.4000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 77 77.500000 3974.4000 0.0000