CMS/EIP Fiscal Report Center: 05
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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 512 2915.250000 108447.3000 37.2000
Subtotal (Total Children Is Unduplicated) 512 2915.250000 108447.3000 37.2000
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Total 2915.250000 108447.3000 37.2000
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Number of Children (Unduplicated) With at Least One Service 512
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Center 05
Flag Claims Units Chgs Paid
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R 7 5.750000 213.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 5257 2635.000000 98022.0000 90979.7800
P 0 0.000000 0.0000 0.0000
D 1 0.250000 9.3000 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
93 51.500000 1915.8000 0.0000
Other 379 222.750000 8286.3000 7272.6000
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Total 5737 2915.250000 108447.3000 98252.3800