CMS/EIP Fiscal Report Center: 09
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:OTHER
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
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 52.000000 2600.0000 50.0000
Subtotal (Total Children Is Unduplicated) 12 52.000000 2600.0000 50.0000
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 30.750000 1537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 52 53.000000 2650.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 25 37.750000 943.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 83 333.000000 16620.0000 49.9099
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 78.000000 5572.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 33 131.000000 9358.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 143 612.000000 43674.2200 71.3631
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 418 20942.00000 9282.6300 0.4433
Subtotal (Total Children Is Unduplicated) 451 22229.00000 89951.4400 4.0466
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Total 22281.000000 92551.4400 4.1538
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Number of Children (Unduplicated) With at Least One Service 451
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Center 09
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 981 19317.500000 71364.8200 71364.8200
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
176 2963.500000 21186.6200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1157 22281.000000 92551.4400 71364.8200