CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 23 29.000000 1073.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 102 187.750000 6946.7500 37.0000
Subtotal (Total Children Is Unduplicated) 120 216.750000 8019.7500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97166-OT EVAL MODERATE COMPLEXITY 13 13.000000 663.6500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 52 52.000000 2654.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 11 11.000000 561.5500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 20 20.000000 1021.0000 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 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 107 111.000000 5666.5500 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 83.000000 4150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1236 11571.00000 578550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1227 11920.00000 119190.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 54 199.000000 14216.5600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 80 495.500000 28342.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 55 322.000000 22512.0200 69.9131
PHY-97110HM-PT SESSION BY PT ASST 48 316.000000 18062.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 142.250000 9962.3400 70.0340
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 1371 25051.75000 795099.9600 31.7383
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Total 25379.500000 808786.2600 31.8677
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Number of Children (Unduplicated) With at Least One Service 1461
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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 37 37.750000 1396.7500 0.0000
P 4083 14639.250000 262961.3200 256393.8700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2757 10492.500000 533615.2100 290.0000
T 0 0.000000 0.0000 0.0000
113 109.500000 4701.5000 0.0000
Other 45 100.500000 6111.4800 480.0000
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Total 7035 25379.500000 808786.2600 257163.8700