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
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
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 12 21.000000 1236.6400 58.8876
PHY-97110-PT SESSION BY LICENSED PT 8 14.000000 682.5200 48.7514
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 19.500000 1393.0800 71.4400
TRAV-TRAVS-Travel by mile 277 12159.00000 5412.4100 0.4451
Subtotal (Total Children Is Unduplicated) 334 13784.00000 49970.9000 3.6253
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Total 13784.000000 49970.9000 3.6253
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Number of Children (Unduplicated) With at Least One Service 334
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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
2137 13784.000000 49970.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2137 13784.000000 49970.9000 0.0000