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
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 15 8.000000 296.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20 34.750000 1285.7500 37.0000
Subtotal (Total Children Is Unduplicated) 32 42.750000 1581.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 24 26.000000 1327.3000 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 220 2069.000000 103450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1105 10614.00000 106140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 109.000000 7644.0800 70.1292
OCCT-97530HM-OT SESSION BY OT ASST 5 34.000000 1944.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 10 54.000000 3536.2800 65.4867
PHY-97110HM-PT SESSION BY PT ASST 9 55.500000 3088.1300 55.6420
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 51.000000 3536.2800 69.3388
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 38.000000 2173.6000 57.2000
Subtotal (Total Children Is Unduplicated) 1148 13070.25000 233800.6700 17.8880
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Total 13139.000000 236709.7200 18.0158
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Number of Children (Unduplicated) With at Least One Service 1173
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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 0 0.000000 0.0000 0.0000
P 3370 13001.750000 231596.6800 231596.6800
D 2 2.000000 74.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 15 50.500000 975.7200 120.0000
T 0 0.000000 0.0000 0.0000
79 40.750000 1507.7500 0.0000
Other 19 44.000000 2555.5700 1595.1800
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Total 3485 13139.000000 236709.7200 233311.8600