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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 119 179.500000 6641.5000 37.0000
Subtotal (Total Children Is Unduplicated) 119 179.500000 6641.5000 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-97167-OT EVAL HIGH COMPLEXITY 27 28.000000 1429.4000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 48 48.000000 2450.4000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 612.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 88 94.000000 4798.7000 51.0500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 880 8425.000000 421250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 59 343.000000 24503.9200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 17 86.500000 4947.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 43 267.500000 19110.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 49 434.500000 24836.0200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 162.750000 11591.1400 71.2205
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
Subtotal (Total Children Is Unduplicated) 969 9720.250000 506296.2800 52.0868
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Total 9993.750000 517736.4800 51.8060
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Number of Children (Unduplicated) With at Least One Service 1083
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Center 04
Flag Claims Units Chgs Paid
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R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 30 30.250000 1119.2500 0.0000
P 181 134.250000 4967.2500 4967.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2281 9420.000000 483194.8300 0.0000
T 0 0.000000 0.0000 0.0000
142 394.250000 27900.1500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2651 9993.750000 517736.4800 4967.2500