CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 33 34.500000 1276.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17 28.500000 1054.5000 37.0000
Subtotal (Total Children Is Unduplicated) 48 63.000000 2331.0000 37.0000
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Screening, Eval, and Assessment,Class #02
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4 4.000000 204.2000 51.0500
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EI Services,Class #03
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 15.250000 381.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 61 351.000000 17550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 118 1041.500000 52000.0000 49.9280
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 513 3496.000000 34960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 5.000000 357.2000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 18.000000 1029.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 9 29.500000 1687.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 4 16.000000 1143.0400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 5.000000 357.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 11.000000 628.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 642.9600 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 5 15.000000 555.0000 37.0000
Subtotal (Total Children Is Unduplicated) 631 5012.250000 111292.4100 22.2041
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Total 5079.250000 113827.6100 22.4103
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Number of Children (Unduplicated) With at Least One Service 669
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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 1360 4930.750000 109799.3700 108089.3700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 22 71.000000 950.0000 900.0000
T 0 0.000000 0.0000 0.0000
144 63.000000 2331.0000 0.0000
Other 6 14.500000 747.2400 568.6400
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Total 1532 5079.250000 113827.6100 109558.0100