CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 31 29.750000 1100.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 109 207.750000 7686.7500 37.0000
Subtotal (Total Children Is Unduplicated) 136 237.500000 8787.5000 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-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 34 34.000000 1735.7000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 19 19.000000 969.9500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 62 62.000000 3165.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 13 13.000000 663.6500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 13 13.000000 636.2200 48.9400
Subtotal (Total Children Is Unduplicated) 151 164.000000 8344.7700 50.8827
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 51.750000 2587.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 77 2982.000000 74550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1246 12902.00000 645100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1244 13417.00000 134170.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 67 289.250000 20664.0200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 99 520.750000 29784.9800 57.1963
PHY-97110-PT SESSION BY LICENSED PT 69 400.750000 28408.1400 70.8874
PHY-97110HM-PT SESSION BY PT ASST 100 530.250000 30309.0900 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 201.000000 14109.4000 70.1960
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 4.000000 228.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 23 26.500000 367.8200 13.8800
Subtotal (Total Children Is Unduplicated) 1419 31325.25000 980279.7500 31.2936
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Total 31726.750000 997412.0200 31.4376
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Number of Children (Unduplicated) With at Least One Service 1478
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Center 04
Flag Claims Units Chgs Paid
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R 1 1.000000 37.0000 37.0000
U 0 0.000000 0.0000 0.0000
B 34 37.500000 1387.5000 0.0000
P 4345 16311.000000 287376.2400 278972.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3021 11940.500000 608737.3700 260.0000
T 0 0.000000 0.0000 0.0000
420 3290.250000 90325.8200 0.0000
Other 68 146.500000 9548.0900 30.0000
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Total 7889 31726.750000 997412.0200 279299.9000