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
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 24 9.250000 344.1000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 30.500000 1134.6000 37.2000
Subtotal (Total Children Is Unduplicated) 38 39.750000 1478.7000 37.2000
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Screening, Eval, and Assessment,Class #02
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 8 8.000000 411.2800 51.4100
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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 161 1138.500000 56925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 15 90.000000 4500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 936 6727.000000 67270.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 23.500000 1691.0600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 16.000000 921.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 3 10.500000 755.5800 71.9600
PHY-97110HM-PT SESSION BY PT ASST 6 26.000000 1496.5600 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 34.500000 2482.6200 71.9600
Subtotal (Total Children Is Unduplicated) 980 8181.750000 141829.9200 17.3349
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Total 8229.500000 143719.9000 17.4640
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Number of Children (Unduplicated) With at Least One Service 1012
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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 2219 8073.250000 137839.8900 137929.8900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 31 113.000000 4170.0000 370.0000
T 0 0.000000 0.0000 0.0000
67 39.750000 1478.7000 0.0000
Other 3 3.500000 231.3100 107.9400
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Total 2320 8229.500000 143719.9000 138407.8300