CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 15 8.000000 296.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 128 188.750000 6983.7500 37.0000
Subtotal (Total Children Is Unduplicated) 129 196.750000 7279.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 27 28.000000 1429.4000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 31 31.000000 1582.5500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 24 24.000000 1225.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 89 96.000000 4900.8000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 23 39.750000 1987.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 5.000000 250.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 65 5424.000000 135600.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1123 10628.00000 531253.0000 49.9862
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1105 10614.00000 106140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 68 410.750000 29129.6600 70.9182
OCCT-97530HM-OT SESSION BY OT ASST 14 67.000000 3832.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 60 273.000000 19181.6400 70.2624
PHY-97110HM-PT SESSION BY PT ASST 33 285.500000 16234.9300 56.8649
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 237.500000 16859.8400 70.9888
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 9 39.000000 2230.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 10 7.000000 97.1600 13.8800
Subtotal (Total Children Is Unduplicated) 1269 28031.50000 862846.9300 30.7813
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Total 28324.250000 875027.4800 30.8932
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Number of Children (Unduplicated) With at Least One Service 1322
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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 46 33.000000 1221.0000 0.0000
P 3516 13162.250000 238526.4600 238326.4600
D 2 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2272 8918.500000 449280.2000 348.6400
T 0 0.000000 0.0000 0.0000
543 6056.500000 176278.6200 0.0000
Other 64 152.000000 9647.2000 3520.3300
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Total 6443 28324.250000 875027.4800 242195.4300