CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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 7 13.500000 502.2000 37.2000
Subtotal (Total Children Is Unduplicated) 7 13.500000 502.2000 37.2000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 76.000000 2052.0000 27.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 8.000000 432.0000 54.0000
Subtotal (Total Children Is Unduplicated) 10 84.000000 2484.0000 29.5714
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Total 97.500000 2986.2000 30.6277
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Number of Children (Unduplicated) With at Least One Service 14
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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 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
89 94.250000 2865.3000 0.0000
Other 3 3.250000 120.9000 0.0000
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Total 92 97.500000 2986.2000 0.0000