CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 15 16.000000 776.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 101 195.000000 9750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 402.5000 73.1818
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 48 87.500000 5842.2500 66.7686
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 98 155.000000 8574.7500 55.3210
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 29.500000 2104.0000 71.3220
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 10.000000 465.4500 46.5450
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 266 531.500000 30031.7500 56.5038
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 128 156.000000 7787.5000 49.9199
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 66 139.000000 6950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.500000 62.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 9.000000 450.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 45.750000 2287.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 299 1771.250000 87595.5900 49.4541
INTR-T1013-INTERPRETER 47 184.000000 9100.0000 49.4565
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1196 8994.000000 89325.2100 9.9316
OCCT-97530-OT SESSION BY LICENSED OT 23 167.750000 11646.7500 69.4292
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 41 227.500000 13505.7100 59.3658
PHY-97110HM-PT SESSION BY PT ASST 2 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 103 628.250000 43580.7300 69.3685
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 742 65686.00000 27673.9100 0.4213
Subtotal (Total Children Is Unduplicated) 1274 78031.50000 300890.8600 3.8560
-----------------------------------------------------------------------------------------------------------------------
Total 78563.000000 330922.6100 4.2122
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1327
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 15979 71022.750000 291105.7600 291105.7600
D 675 3132.250000 24630.6100 10.0000
S 36 55.000000 3790.0000 112.5000
H 0 0.000000 0.0000 0.0000
T 670 3681.500000 9757.8500 9757.8200
105 671.500000 1638.3900 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17465 78563.000000 330922.6100 301036.0800