CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 7 7.000000 354.8000 50.6857
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 245.8200 81.9400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 109 102.000000 5100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 217 498.500000 24925.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 115 363.000000 18150.0000 50.0000
INTR-T1013-INTERPRETER 10 72.000000 2981.3200 41.4072
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 498 2500.000000 24831.0000 9.9324
OCCT-97530-OT SESSION BY LICENSED OT 27 116.500000 8132.8500 69.8099
PHY-97110-PT SESSION BY LICENSED PT 18 75.250000 4969.7400 66.0431
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 187.000000 12759.0100 68.2300
TRAV-TRAVS-Travel by mile 434 33664.00000 14985.1400 0.4451
Subtotal (Total Children Is Unduplicated) 502 37585.00000 117173.6300 3.1176
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Total 37592.000000 117528.4300 3.1264
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Number of Children (Unduplicated) With at Least One Service 502
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Center 03
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 0 0.000000 0.0000 0.0000
6027 37592.000000 117528.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6027 37592.000000 117528.4300 0.0000