CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 4 2.500000 92.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 12 24.000000 888.0000 37.0000
Subtotal (Total Children Is Unduplicated) 16 26.500000 980.5000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 25 25.000000 1276.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 42 48.000000 2450.4000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 69.750000 3487.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 227 1990.000000 99500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1120 11007.00000 110070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 158.000000 11287.5200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 15 62.500000 3575.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 9 49.500000 3393.4000 68.5535
PHY-97110HM-PT SESSION BY PT ASST 11 68.000000 3886.8800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 70.000000 5000.8000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 171.6000 57.2000
Subtotal (Total Children Is Unduplicated) 1170 13490.75000 241022.7000 17.8658
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Total 13565.250000 244453.6000 18.0206
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Number of Children (Unduplicated) With at Least One Service 1184
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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 3378 13434.250000 238997.3600 238997.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 81.000000 3130.0100 350.0000
T 0 0.000000 0.0000 0.0000
35 26.500000 980.5000 0.0000
Other 9 23.500000 1345.7300 180.0000
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Total 3441 13565.250000 244453.6000 239527.3600