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: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 104 155.250000 5744.2500 37.0000
Subtotal (Total Children Is Unduplicated) 104 155.250000 5744.2500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 11 11.000000 561.5500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 5 5.000000 255.2500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 9 9.000000 459.4500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 35 41.000000 2093.0500 51.0500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 887 7888.000000 393567.0000 49.8944
OCCT-97530-OT SESSION BY LICENSED OT 22 166.750000 11912.6200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 15 121.750000 8697.8200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 7 46.000000 2629.3600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 139.500000 9965.8800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 171.6000 57.2000
Subtotal (Total Children Is Unduplicated) 922 8365.000000 426944.2800 51.0394
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Total 8561.250000 434781.5800 50.7848
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Number of Children (Unduplicated) With at Least One Service 1012
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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 178 138.250000 5115.2500 5115.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2321 8119.000000 408962.2400 0.0000
T 0 0.000000 0.0000 0.0000
113 286.250000 20033.2900 0.0000
Other 1 1.000000 51.0500 0.0000
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Total 2629 8561.250000 434781.5800 5115.2500