CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 36 29.000000 1073.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 112 211.250000 7816.2500 37.0000
Subtotal (Total Children Is Unduplicated) 133 240.250000 8889.2500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 33 33.000000 1602.6900 48.5664
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 24 24.000000 1225.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 19 19.000000 969.9500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 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 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 94 100.000000 5023.0400 50.2304
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 64.000000 3200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1181 10666.00000 533220.0000 49.9925
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 61 81.000000 4050.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1193 11133.00000 111330.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 50 199.000000 13357.7800 67.1245
OCCT-97530GT-OT SESSION BY LICENSED OT 2 3.500000 125.0400 35.7257
OCCT-97530HM-OT SESSION BY OT ASST 85 503.250000 28671.5000 56.9727
OCCT-97530HMGT-OT SESSION BY OT ASST 3 12.000000 686.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 50 283.500000 19741.8800 69.6363
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.000000 379.5900 63.2650
PHY-97110HM-PT SESSION BY PT ASST 47 369.000000 21092.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 175.500000 12083.2400 68.8504
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 3.000000 111.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1335 23498.75000 748048.4700 31.8335
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Total 23839.000000 761960.7600 31.9628
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Number of Children (Unduplicated) With at Least One Service 1439
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Center 04
Flag Claims Units Chgs Paid
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R 3 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 78.000000 2886.0000 0.0000
P 4017 13318.250000 236731.1000 227253.8300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2903 10028.500000 501926.4200 2920.0000
T 0 0.000000 0.0000 0.0000
177 182.250000 7796.2500 0.0000
Other 95 231.000000 12583.9900 1666.0000
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Total 7288 23839.000000 761960.7600 231839.8300