CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 12 6.250000 231.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 130 192.500000 7122.5000 37.0000
Subtotal (Total Children Is Unduplicated) 132 198.750000 7353.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.000000 153.1500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 22 22.000000 1123.1000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 7 7.000000 357.3500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 16 16.000000 816.8000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 612.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 12 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 66 73.000000 3726.6500 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 50.500000 2525.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 64 5371.000000 134275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1076 9633.500000 480842.0000 49.9135
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1050 9334.000000 93340.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 46 285.750000 20293.9800 71.0201
OCCT-97530HM-OT SESSION BY OT ASST 5 29.500000 1687.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 49 203.500000 14538.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 19 111.000000 6344.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 262.000000 18669.0400 71.2559
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 23.000000 1315.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 6 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 1217 25309.75000 774022.4600 30.5820
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Total 25581.500000 785102.8600 30.6903
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Number of Children (Unduplicated) With at Least One Service 1266
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Center 04
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 16 16.750000 619.7500 0.0000
P 3491 11387.250000 199651.9900 199651.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2350 8160.000000 409433.6800 281.4400
T 0 0.000000 0.0000 0.0000
466 5893.500000 167523.3500 0.0000
Other 56 124.000000 7874.0900 1055.1400
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Total 6379 25581.500000 785102.8600 200988.5700