CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 2.000000 89.2400 44.6200
Subtotal (Total Children Is Unduplicated) 3 2.000000 89.2400 44.6200
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Total 2.000000 89.2400 44.6200
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Number of Children (Unduplicated) With at Least One Service 3
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Center 06
Flag Claims Units Chgs Paid
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R 3 2.000000 89.2400 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3 2.000000 89.2400 0.0000