CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EXT
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 74 103.000000 3811.0000 37.0000
Subtotal (Total Children Is Unduplicated) 74 103.000000 3811.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 14 14.000000 679.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 8 8.000000 388.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 18 18.000000 873.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 9 9.000000 436.5000 48.5000
Subtotal (Total Children Is Unduplicated) 45 50.000000 2425.0000 48.5000
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 832 7617.250000 380662.5000 49.9737
OCCT-97530-OT SESSION BY LICENSED OT 67 378.000000 25658.6400 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 11 69.500000 3775.2400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 44 193.750000 13151.7500 67.8800
PHY-97110HM-PT SESSION BY PT ASST 15 83.500000 4535.7200 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 198.000000 13440.2400 67.8800
Subtotal (Total Children Is Unduplicated) 902 8545.000000 441349.0900 51.6500
-----------------------------------------------------------------------------------------------------------------------
Total 8698.000000 447585.0900 51.4584
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 951
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 71.000000 2627.0000 0.0000
P 51 34.750000 1324.7500 1324.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2443 8141.250000 413609.8000 297069.7200
T 0 0.000000 0.0000 0.0000
226 447.500000 29785.9600 0.0000
Other 1 3.500000 237.5800 237.5800
---------------------------------------------------------
Total 2816 8698.000000 447585.0900 298632.0500