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
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 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 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 290.0000 72.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 59.500000 3742.2500 62.8950
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 106.500000 5883.0000 55.2394
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.000000 716.5000 65.1364
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 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) 209 417.500000 22607.4500 54.1496
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 126 154.000000 7687.5000 49.9188
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 290 1721.500000 85108.0900 49.4383
INTR-T1013-INTERPRETER 47 184.000000 9100.0000 49.4565
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1196 8993.000000 89315.2100 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 38 212.500000 12454.5000 58.6094
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 586.250000 40618.2500 69.2849
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 741 65653.00000 27659.2200 0.4213
Subtotal (Total Children Is Unduplicated) 1273 77886.75000 294150.6600 3.7766
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Total 78304.250000 316758.1100 4.0452
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Number of Children (Unduplicated) With at Least One Service 1310
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Center 01
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 15937 70980.000000 288647.2900 288647.2900
D 562 3001.750000 16758.8400 10.0000
S 9 12.500000 602.5000 112.5000
H 0 0.000000 0.0000 0.0000
T 664 3642.500000 9362.3400 9362.3100
101 667.500000 1387.1400 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 17273 78304.250000 316758.1100 298182.1000