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
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
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 26.0500 26.0500
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 214.9600 53.7400
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 10 20.000000 1253.1800 62.6590
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 357.3500 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 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 35 52.500000 3125.5900 59.5350
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 268.6000 134.3000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 85 100.000000 5000.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 85 129.250000 6462.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 67 107.250000 5362.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 11.750000 587.5000 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 43 264.500000 13225.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 445 3271.000000 32710.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 49 211.000000 14717.2800 69.7501
OCCT-97530HM-OT SESSION BY OT ASST 14 59.250000 3389.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 50 275.750000 18829.3400 68.2841
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 146 834.750000 55171.6100 66.0936
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 12.0800 12.0800
TRAV-TRAVS-Travel by mile 311 27335.00000 12165.9000 0.4451
Subtotal (Total Children Is Unduplicated) 473 32640.25000 169682.6600 5.1986
-----------------------------------------------------------------------------------------------------------------------
Total 32692.750000 172808.2500 5.2858
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 476
-----------------------------------------------------------------------------------------------------------------------
Center 52
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 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 3500 32681.750000 172587.3600 172587.3600
3 8.000000 60.8900 60.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3504 32692.750000 172808.2500 172808.2500