CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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
EXIT-EXIT-EXIT ASSESSMENT 17 25.000000 1250.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 56.2500 56.2500
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 54.000000 4050.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 31.500000 1748.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 51.0500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 38.2900 38.2900
Subtotal (Total Children Is Unduplicated) 57 132.500000 8570.9400 64.6863
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 9.000000 4549.1600 505.4622
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 21.000000 1050.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 39 46.750000 2300.0000 49.1979
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.500000 75.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 2.250000 112.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 53 272.250000 13612.5000 50.0000
INTR-T1013-INTERPRETER 13 46.500000 2325.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 376 2431.000000 24310.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 74.000000 5286.5600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 29 200.000000 11718.0800 58.5904
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 82 686.500000 48792.0400 71.0736
TRAV-TRAVS-Travel by mile 138 7388.000000 3262.1000 0.4415
Subtotal (Total Children Is Unduplicated) 477 11181.75000 117453.9400 10.5041
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Total 11314.250000 126024.8800 11.1386
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Number of Children (Unduplicated) With at Least One Service 483
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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 1 1.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3694 10858.250000 111424.1700 81981.3500
422 441.750000 14534.2000 121.4400
Other 6 13.250000 56.5100 40.0000
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Total 4123 11314.250000 126024.8800 82142.7900