CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 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 103 132.750000 4938.3000 37.2000
Subtotal (Total Children Is Unduplicated) 103 132.750000 4938.3000 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 6 6.000000 308.4600 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 6 6.000000 329.0100 54.8350
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 19 20.000000 1048.7500 52.4375
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 866 8265.000000 413250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 19 104.000000 5200.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 94.000000 6764.2400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 10 69.500000 4003.2000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 14.000000 1007.4400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 8 47.000000 3382.1200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 14 123.000000 7079.8800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 18.000000 1295.2800 71.9600
Subtotal (Total Children Is Unduplicated) 894 8734.500000 441982.1600 50.6019
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Total 8887.250000 447969.2100 50.4058
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Number of Children (Unduplicated) With at Least One Service 992
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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 22 14.750000 548.7000 0.0000
P 219 151.750000 6730.4300 4359.1000
D 2 0.750000 27.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 8764 8719.500000 440626.2000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 0.500000 35.9800 0.0000
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Total 9008 8887.250000 447969.2100 4359.1000