CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 24 38.000000 1900.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 37.500000 2812.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 10.000000 700.0000 70.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 32.500000 1803.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 59 136.500000 8480.4000 62.1275
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 10210.4700 1458.6386
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 22.250000 1000.0000 44.9438
CONIF-CONIF-CONSULT, FACE TO FACE 32 37.000000 1775.0000 47.9730
CONIP-CONIP-CONSULT, PHONE 1 5.750000 143.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 46 186.500000 9325.0000 50.0000
INTR-T1013-INTERPRETER 10 43.500000 2160.0000 49.6552
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 352 2411.000000 23520.0000 9.7553
OCCT-97530-OT SESSION BY LICENSED OT 18 88.750000 6282.2500 70.7859
PHY-97110-PT SESSION BY LICENSED PT 9 83.000000 3055.3700 36.8117
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 88 643.500000 45118.6900 70.1145
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 150 11069.00000 4678.7850 0.4227
Subtotal (Total Children Is Unduplicated) 433 14598.25000 107283.1950 7.3490
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Total 14734.750000 115763.5950 7.8565
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Number of Children (Unduplicated) With at Least One Service 435
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Center 02
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1011 4159.500000 29289.7400 5154.4250
2582 10522.250000 86070.3800 30.0000
Other 8 53.000000 403.4750 0.0000
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Total 3601 14734.750000 115763.5950 5184.4250