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
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 18 5.250000 194.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 15 19.750000 730.7500 37.0000
Subtotal (Total Children Is Unduplicated) 32 25.000000 925.0000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97167-OT EVAL HIGH COMPLEXITY 15 15.000000 765.7500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 22 24.000000 1225.2000 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 196 2073.000000 103650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1143 12206.00000 122060.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 29 176.500000 12609.1600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 15 97.000000 5548.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 3 19.000000 1357.3600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 8 38.000000 2172.0800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 40.000000 2857.6000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 8.500000 486.2000 57.2000
Subtotal (Total Children Is Unduplicated) 1184 14722.75000 253978.3000 17.2507
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Total 14771.750000 256128.5000 17.3391
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Number of Children (Unduplicated) With at Least One Service 1203
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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 3652 14716.750000 254401.0100 254189.4100
D 2 1.250000 46.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 8 26.000000 620.0000 170.0000
T 0 0.000000 0.0000 0.0000
39 23.750000 878.7500 0.0000
Other 5 4.000000 182.4900 60.0000
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Total 3706 14771.750000 256128.5000 254419.4100