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
Payclass Filters:GR
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 16 29.250000 1082.2500 37.0000
Subtotal (Total Children Is Unduplicated) 52 58.250000 2155.2500 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 15 16.000000 816.8000 51.0500
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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 228 1802.000000 90100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 28.000000 1400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1193 11133.00000 111330.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 34.500000 2264.6800 65.6429
OCCT-97530HM-OT SESSION BY OT ASST 22 133.750000 7536.1000 56.3447
OCCT-97530HMGT-OT SESSION BY OT ASST 1 9.000000 514.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 43.000000 2584.3600 60.1014
PHY-97110HM-PT SESSION BY PT ASST 4 21.000000 1200.3600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 32.500000 2321.8000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 3.000000 111.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1242 13303.75000 222563.1000 16.7294
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Total 13378.000000 225535.1500 16.8587
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Number of Children (Unduplicated) With at Least One Service 1277
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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 0 0.000000 0.0000 0.0000
P 3854 13009.750000 218723.9000 218723.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 81 243.000000 2990.0000 2920.0000
T 0 0.000000 0.0000 0.0000
100 58.250000 2155.2500 0.0000
Other 24 67.000000 1666.0000 1666.0000
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Total 4059 13378.000000 225535.1500 223309.9000