CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
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
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 103.000000 5150.0000 50.0000
Subtotal (Total Children Is Unduplicated) 25 110.000000 5625.0000 51.1364
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 35 47.250000 2362.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 8.750000 218.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 18 38.500000 1925.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 19.250000 962.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 7.000000 175.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 35.000000 1750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 146 665.000000 33250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 118.000000 8360.3400 70.8503
PHY-97110-PT SESSION BY LICENSED PT 36 152.000000 10665.5600 70.1682
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 145 752.000000 53551.2800 71.2118
TRAV-TRAVS-Travel by mile 679 43308.00000 19175.9100 0.4428
Subtotal (Total Children Is Unduplicated) 710 45155.75000 132621.8400 2.9370
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Total 45265.750000 138246.8400 3.0541
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Number of Children (Unduplicated) With at Least One Service 713
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Center 09
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 1927 45260.750000 137946.8400 137946.8400
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
3 5.000000 300.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1930 45265.750000 138246.8400 137946.8400