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
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 2 2.000000 100.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 130.1700 32.5425
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 15 18.000000 835.1200 46.3956
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 209 246.500000 12325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 242 469.250000 23462.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.250000 56.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 129 294.250000 14712.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 78 130.000000 6500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 198 304.750000 15237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 160 732.000000 36600.0000 50.0000
INTR-T1013-INTERPRETER 40 681.000000 24293.7500 35.6736
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 658 4847.000000 48470.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 181.500000 12220.6900 67.3316
PHY-97110-PT SESSION BY LICENSED PT 38 170.250000 9870.2400 57.9750
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 285.000000 19420.2400 68.1412
TRAV-TRAVS-Travel by mile 581 74917.00000 33346.3700 0.4451
Subtotal (Total Children Is Unduplicated) 686 83263.25000 256577.5400 3.0815
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Total 83281.250000 257412.6600 3.0909
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Number of Children (Unduplicated) With at Least One Service 686
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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
11901 83281.250000 257412.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11901 83281.250000 257412.6600 0.0000