CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 5 2.000000 74.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 135 194.000000 7178.0000 37.0000
Subtotal (Total Children Is Unduplicated) 135 196.000000 7252.0000 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-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 46 47.000000 2349.3500 49.9862
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 48 48.000000 2430.4000 50.6333
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 14 14.000000 669.7000 47.8357
Subtotal (Total Children Is Unduplicated) 114 120.000000 6011.0000 50.0917
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 45 110.250000 5512.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 70 5677.000000 141925.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1183 12107.00000 605350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1203 12538.00000 125380.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 101 534.500000 37572.8000 70.2952
OCCT-97530HM-OT SESSION BY OT ASST 55 334.000000 19104.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 69 373.500000 25828.1000 69.1515
PHY-97110HM-PT SESSION BY PT ASST 101 494.500000 28265.6200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 442.000000 31207.5900 70.6054
Subtotal (Total Children Is Unduplicated) 1394 32612.75000 1020246.4100 31.2837
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Total 32928.750000 1033509.4100 31.3862
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Number of Children (Unduplicated) With at Least One Service 1428
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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 44 44.750000 1655.7500 0.0000
P 4069 15459.750000 281215.7600 275044.1400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2572 10922.000000 554677.3900 834.6400
T 0 0.000000 0.0000 0.0000
514 6290.250000 181899.0400 0.0000
Other 78 212.000000 14061.4700 347.1600
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Total 7277 32928.750000 1033509.4100 276225.9400