CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3 2.000000 65.1000 32.5500
TCM-T1017TL-TARGETED CASE MANAGEMENT 4 12.250000 455.7000 37.2000
Subtotal (Total Children Is Unduplicated) 5 14.250000 520.8000 36.5474
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Total 14.250000 520.8000 36.5474
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Number of Children (Unduplicated) With at Least One Service 5
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Center 06
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 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
18 14.250000 520.8000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18 14.250000 520.8000 0.0000