CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.250000 9.2500 37.0000
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.000000 761.1300 47.5706
EXIT-EXIT-EXIT ASSESSMENT 176 348.750000 17375.0000 49.8208
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 102.5000 68.3333
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 33.500000 2184.6400 65.2131
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 75.000000 3954.4900 52.7265
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.500000 896.6000 57.8452
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 48.5000 48.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 254 493.250000 25424.9600 51.5458
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 1991.6900 995.8450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 171 228.250000 11087.5000 48.5761
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 80 190.500000 9525.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 19.500000 975.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 43.000000 2150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 66 133.500000 6675.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 154 713.250000 35579.5000 49.8836
INTR-T1013-INTERPRETER 98 359.250000 17957.5000 49.9861
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1378 11333.00000 112736.9300 9.9477
OCCT-97530-OT SESSION BY LICENSED OT 13 61.000000 4151.6800 68.0603
PHY-97110-PT SESSION BY LICENSED PT 25 158.000000 10683.9100 67.6197
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 390.500000 26081.5800 66.7902
TRAV-TRAVS-Travel by mile 778 74112.00000 31845.2100 0.4297
Subtotal (Total Children Is Unduplicated) 1439 87743.75000 271440.5000 3.0936
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Total 88237.250000 296874.7100 3.3645
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Number of Children (Unduplicated) With at Least One Service 1461
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Center 01
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 17416 75893.750000 267894.6000 267894.6000
D 748 4850.000000 12894.0700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1153 7346.750000 15746.0400 15746.0400
19 146.750000 340.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19336 88237.250000 296874.7100 283640.6400