CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 3 4.000000 148.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 107 122.000000 4538.4000 37.2000
Subtotal (Total Children Is Unduplicated) 109 126.000000 4687.2000 37.2000
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Screening, Eval, and Assessment,Class #02
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 514.1000 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 11 11.000000 565.5100 51.4100
PSTH-97161GT-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 10 10.000000 514.1000 51.4100
Subtotal (Total Children Is Unduplicated) 40 43.000000 2210.6300 51.4100
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 27.250000 1375.0000 50.4587
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 67 3086.000000 77150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1068 7582.000000 379050.0000 49.9934
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 89.000000 4450.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 778 5664.000000 84795.0000 14.9709
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 327 2103.000000 25188.0000 11.9772
OCCT-97530-OT SESSION BY LICENSED OT 38 160.000000 11457.5600 71.6098
OCCT-97530HM-OT SESSION BY OT ASST 14 36.000000 1870.7200 51.9644
OCCT-97530TL-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 46 164.000000 11713.6000 71.4244
PHY-97110HM-PT SESSION BY PT ASST 32 135.000000 7770.6000 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 199.500000 14356.0200 71.9600
SPL-92508HA-GROUP SPL SESSION PER CHILD 3 6.000000 83.7600 13.9600
Subtotal (Total Children Is Unduplicated) 1231 19255.75000 619548.1000 32.1747
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Total 19424.750000 626445.9300 32.2499
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Number of Children (Unduplicated) With at Least One Service 1265
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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 87 61.000000 2269.2000 0.0000
P 2596 9998.500000 224176.4800 223145.4500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1521 5818.500000 292273.4300 225.0000
T 0 0.000000 0.0000 0.0000
259 3247.750000 86832.9500 0.0000
Other 139 299.000000 20893.8700 727.9300
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Total 4602 19424.750000 626445.9300 224098.3800