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:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 97 182.000000 6734.0000 37.0000
Subtotal (Total Children Is Unduplicated) 97 182.000000 6734.0000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 21 21.000000 1072.0500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 18 18.000000 918.9000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 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 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 59 61.000000 3114.0500 51.0500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 962 8739.000000 436870.0000 49.9908
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 53.000000 2650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 81.500000 5822.3600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 54 316.000000 18075.2000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 27 147.000000 10501.6800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.000000 214.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 43 347.000000 19834.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 21.500000 1535.9600 71.4400
Subtotal (Total Children Is Unduplicated) 1025 9710.000000 495618.4400 51.0421
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Total 9953.000000 505466.4900 50.7853
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Number of Children (Unduplicated) With at Least One Service 1126
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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 69 89.500000 4245.9200 2220.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2810 9739.500000 496606.5700 0.0000
T 0 0.000000 0.0000 0.0000
50 45.000000 1691.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3025 9953.000000 505466.4900 2220.0000