CMS/EIP Fiscal Report Center: 05
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:MED
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 58 233.000000 10643.4400 45.6800
Subtotal (Total Children Is Unduplicated) 58 233.000000 10643.4400 45.6800
-----------------------------------------------------------------------------------------------------------------------
Total 233.000000 10643.4400 45.6800
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 58
-----------------------------------------------------------------------------------------------------------------------
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 297 230.750000 10540.6600 3768.2700
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
2 2.250000 102.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 299 233.000000 10643.4400 3768.2700