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
Payclass Filters:GR
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 26 37.250000 1378.2500 37.0000
Subtotal (Total Children Is Unduplicated) 37 43.500000 1609.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 5 5.000000 255.2500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 7 7.000000 357.3500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 22 22.000000 1123.1000 51.0500
-----------------------------------------------------------------------------------------------------------------------
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 189 1654.500000 82725.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1050 9334.000000 93340.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 72.000000 5023.6800 69.7733
OCCT-97530HM-OT SESSION BY OT ASST 2 17.000000 972.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 7 25.000000 1786.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 12 65.000000 3715.4000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 42.500000 2987.9600 70.3049
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 18.500000 1058.2000 57.2000
Subtotal (Total Children Is Unduplicated) 1094 11282.00000 194283.6400 17.2207
-----------------------------------------------------------------------------------------------------------------------
Total 11347.500000 197016.2400 17.3621
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1120
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 3312 11248.000000 194465.3000 194465.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 29 41.000000 471.4400 281.4400
T 0 0.000000 0.0000 0.0000
63 43.500000 1609.5000 0.0000
Other 9 15.000000 470.0000 410.0000
---------------------------------------------------------
Total 3413 11347.500000 197016.2400 195156.7400