CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Payclass Filters:TPIN
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
OCTH-97165-OT EVAL LOW 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) 2 2.000000 102.1000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 37 37.500000 1875.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 114 159.750000 7987.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 37 44.000000 2200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 9.000000 450.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 14.000000 700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 85 197.750000 9887.5000 50.0000
INTR-T1013-INTERPRETER 34 332.500000 10386.2500 31.2368
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 302 776.000000 7760.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 32.000000 2022.4800 63.2025
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 286.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 9 15.000000 753.9600 50.2640
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 35.500000 2536.1200 71.4400
TRAV-TRAVS-Travel by mile 277 12159.00000 5412.4100 0.4451
Subtotal (Total Children Is Unduplicated) 349 13819.00000 52371.5400 3.7898
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Total 13821.000000 52473.6400 3.7967
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Number of Children (Unduplicated) With at Least One Service 350
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Center 03
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 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
2174 13821.000000 52473.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2174 13821.000000 52473.6400 0.0000