CMS/EIP Fiscal Report Center: 55
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 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 26.000100 1950.0000 74.9997
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 48 96.000100 7200.0000 74.9999
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 112.500000 8437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 26.000000 1443.0000 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 3 3.000000 153.1500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 18 18.000000 918.9000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 6 6.000100 306.3000 51.0491
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 154 311.500300 21861.1000 70.1800
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 130.2000 65.1000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 2 1.750000 87.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 5.000000 125.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 45 43.000000 2150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 41 49.000000 1225.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 7.000000 350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 18 22.000000 550.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 40 38.500000 1925.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 16.500000 412.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 36.000000 900.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 255 1503.000000 75150.0000 50.0000
INTR-T1013-INTERPRETER 3 10.000000 435.4200 43.5420
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 627 5365.000000 53650.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 129 675.894598 48285.7600 71.4398
OCCT-97530HM-OT SESSION BY OT ASST 112 646.250000 36965.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 99 538.997199 38532.8807 71.4899
PHY-97110HM-PT SESSION BY PT ASST 52 292.750100 16733.5900 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 296 1793.999900 128163.3600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 66 2172.000000 967.0500 0.4452
Subtotal (Total Children Is Unduplicated) 675 13228.64180 406913.6807 30.7601
-----------------------------------------------------------------------------------------------------------------------
Total 13540.142097 428774.7807 31.6669
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 731
-----------------------------------------------------------------------------------------------------------------------
Center 55
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 8480 10005.078942 208255.0111 208255.0100
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 0 0.000000 0.0000 0.0000
3963 3535.063155 220519.7696 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12443 13540.142097 428774.7807 208255.0100