CMS/EIP Fiscal Report Statewide
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 30 115.000000 5880.2500 51.1326
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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 19 39.750000 1987.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 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 31 39.000000 1950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 154 683.750000 34187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 20 52.000000 520.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 121.000000 8574.6600 70.8650
OCCT-97530HM-OT SESSION BY OT ASST 7 48.000000 2745.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 42 173.750000 12219.3800 70.3274
PHY-97110HM-PT SESSION BY PT ASST 3 32.000000 1829.1200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 162 818.750000 58319.9000 71.2304
TRAV-TRAVS-Travel by mile 688 43531.00000 19275.1500 0.4428
Subtotal (Total Children Is Unduplicated) 758 45628.25000 145652.5600 3.1922
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Total 45743.250000 151532.8100 3.3127
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Number of Children (Unduplicated) With at Least One Service 764
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Center 09
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 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
---------------------------------------------------------
Total 1930 45265.750000 138246.8400 137946.8400
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 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 0 0.000000 0.0000 0.0000
47 268.500000 3815.7900 2520.9800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 47 268.500000 3815.7900 2520.9800
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 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 0 0.000000 0.0000 0.0000
120 120.000000 7605.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 120 120.000000 7605.1800 0.0000
Center 57
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 50.0000 50.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 29 88.000000 1815.0000 1815.0000
---------------------------------------------------------
Total 30 89.000000 1865.0000 1865.0000