CMS/EIP Fiscal Report Center: 05
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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 205 504.250000 18758.1000 37.2000
Subtotal (Total Children Is Unduplicated) 205 504.250000 18758.1000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 119.8400 59.9200
Subtotal (Total Children Is Unduplicated) 1 2.000000 119.8400 59.9200
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 25.000000 1350.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.000000 585.1200 48.7600
PHY-97110-PT SESSION BY LICENSED PT 1 1.750000 142.3100 81.3200
Subtotal (Total Children Is Unduplicated) 14 38.750000 2077.4300 53.6111
-----------------------------------------------------------------------------------------------------------------------
Total 545.000000 20955.3700 38.4502
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 209
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 5.750000 213.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 944 467.500000 17391.0000 13299.0700
P 38 37.750000 2035.2700 2035.2700
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
16 8.500000 366.6000 162.0000
Other 41 25.500000 948.6000 0.0000
---------------------------------------------------------
Total 1046 545.000000 20955.3700 15496.3400