CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 24 9.250000 344.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 103 146.000000 5431.2000 37.2000
Subtotal (Total Children Is Unduplicated) 109 155.250000 5775.3000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 7 7.000000 359.8700 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 257.0500 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 8 8.000000 365.9600 45.7450
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 257.0500 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 13.000000 668.3300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 38 43.000000 2165.3100 50.3560
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 59.750000 2987.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 12 55.000000 2750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 913 6530.500000 326275.0000 49.9617
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 54 269.000000 13450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 936 6727.000000 67270.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 169.500000 12098.2200 71.3759
OCCT-97530HM-OT SESSION BY OT ASST 12 61.000000 3513.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 21 88.000000 5877.0300 66.7844
PHY-97110HM-PT SESSION BY PT ASST 17 85.000000 4886.4500 57.4876
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 100.500000 7231.9800 71.9600
Subtotal (Total Children Is Unduplicated) 1054 14146.25000 446389.7800 31.5553
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Total 14344.500000 454330.3900 31.6728
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Number of Children (Unduplicated) With at Least One Service 1130
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Center 04
Flag Claims Units Chgs Paid
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R 1 0.250000 9.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 13.000000 483.6000 0.0000
P 2304 8235.000000 148275.9000 142877.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1589 5875.500000 294660.6000 497.8600
T 0 0.000000 0.0000 0.0000
185 139.250000 5180.1000 0.0000
Other 41 81.500000 5720.8900 107.9400
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Total 4134 14344.500000 454330.3900 143483.0700