CMS/EIP Fiscal Report Center: 52
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
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 51.0500 25.5250
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 6.000000 300.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 100.000000 7050.0000 70.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 10 10.000000 510.5000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 90 175.000000 11827.3000 67.5846
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 268.6000 134.3000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 88 103.000000 5150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 85 131.250000 6562.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 67 108.750000 5437.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 12.750000 637.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 33.500000 1675.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 159 1008.000000 50056.0200 49.6588
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 445 3272.000000 32720.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 73 320.750000 22087.7600 68.8629
OCCT-97530HM-OT SESSION BY OT ASST 19 87.250000 4990.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 68 394.000000 27057.9000 68.6749
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 203 1314.500000 86008.5300 65.4306
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 12.0800 12.0800
TRAV-TRAVS-Travel by mile 311 27343.00000 12169.4600 0.4451
Subtotal (Total Children Is Unduplicated) 476 34136.00000 254939.8000 7.4684
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Total 34311.000000 266767.1000 7.7750
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Number of Children (Unduplicated) With at Least One Service 493
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Center 52
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 1 3.000000 160.0000 160.0000
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 3502 32689.250000 173005.2400 172825.0600
747 1618.750000 93601.8600 540.8500
Other 0 0.000000 0.0000 0.0000
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Total 4250 34311.000000 266767.1000 173525.9100