CMS/EIP Fiscal Report Center: 06
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
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 17 28.250000 1412.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 20 35.250000 1874.5500 53.1787
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 106.500000 5285.0000 49.6244
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 4.500000 112.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 21 23.500000 1175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 10.000000 250.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 20.000000 1000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 9.750000 243.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 81 422.000000 20800.0000 49.2891
INTR-T1013-INTERPRETER 11 71.000000 4498.0000 63.3521
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1200 9984.000000 99620.0000 9.9780
OCCT-97530-OT SESSION BY LICENSED OT 20 65.000000 4500.7200 69.2418
OCCT-97530HM-OT SESSION BY OT ASST 3 9.750000 557.5000 57.1795
PHY-97110-PT SESSION BY LICENSED PT 34 117.500000 7858.4000 66.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 250.750000 17843.5800 71.1608
SPL-92508-GROUP SPL SESSION PER CHILD 9 171.500000 2255.9200 13.1541
Subtotal (Total Children Is Unduplicated) 1213 11281.00000 166631.6200 14.7710
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Total 11316.250000 168506.1700 14.8906
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Number of Children (Unduplicated) With at Least One Service 1213
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Center 06
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 6743 6606.750000 99238.9600 99238.9600
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
4759 4709.500000 69267.2100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11502 11316.250000 168506.1700 99238.9600