CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 18 5.250000 194.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 149 204.250000 7557.2500 37.0000
Subtotal (Total Children Is Unduplicated) 150 209.500000 7751.5000 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-97167-OT EVAL HIGH COMPLEXITY 35 35.000000 1786.7500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 48 49.000000 2501.4500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 26 26.000000 1327.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 111 120.000000 6126.0000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 32 53.750000 2687.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 6.000000 300.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 69 5628.000000 140700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1135 11844.00000 592200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1143 12206.00000 122060.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 96 613.250000 43774.8600 71.3818
OCCT-97530HM-OT SESSION BY OT ASST 25 194.000000 11096.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 71 298.250000 21235.5400 71.2005
PHY-97110HM-PT SESSION BY PT ASST 74 479.750000 27422.5100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 67 329.500000 23539.4800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 25.000000 1430.0000 57.2000
Subtotal (Total Children Is Unduplicated) 1317 31682.50000 986696.6900 31.1433
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Total 32012.000000 1000574.1900 31.2562
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Number of Children (Unduplicated) With at Least One Service 1377
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Center 04
Flag Claims Units Chgs Paid
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R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 75.000000 2775.0000 0.0000
P 3774 14879.000000 263104.2300 262892.6300
D 2 1.250000 46.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 2555 10435.500000 530386.2700 170.0000
T 0 0.000000 0.0000 0.0000
636 6419.500000 190994.6700 0.0000
Other 86 201.500000 13258.5200 396.8100
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Total 7141 32012.000000 1000574.1900 263459.4400