CMS/EIP Fiscal Report Center: 02
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
EXIT-EXIT-EXIT ASSESSMENT 22 27.000000 1350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 38.000000 2850.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 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 3 3.000000 153.1500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 3.000000 138.1500 46.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 66 151.000000 9621.6500 63.7195
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 1279.4400 319.8600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 22 24.750000 1237.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 104 86.750000 4337.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 69 50.000000 2500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 47 225.500000 11275.0000 50.0000
INTR-T1013-INTERPRETER 11 43.250000 2162.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 403 2615.000000 26073.5600 9.9708
OCCT-97530-OT SESSION BY LICENSED OT 27 164.000000 11155.6600 68.0223
PHY-97110-PT SESSION BY LICENSED PT 35 162.750000 9703.7500 59.6237
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 81 531.750000 37818.1200 71.1201
TRAV-TRAVS-Travel by mile 152 7755.000000 3439.1000 0.4435
Subtotal (Total Children Is Unduplicated) 503 11674.25000 111519.6300 9.5526
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Total 11825.250000 121141.2800 10.2443
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Number of Children (Unduplicated) With at Least One Service 510
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4286 11415.750000 113731.9600 113599.8200
222 253.500000 7339.8800 0.0000
Other 7 156.000000 69.4400 0.0000
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Total 4515 11825.250000 121141.2800 113599.8200