CMS/EIP Fiscal Report Center: 07
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
EXIT-EXIT-EXIT ASSESSMENT 22 36.250000 1812.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.500000 797.7000 69.3652
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 75.0000 50.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 23.000000 1276.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 51 85.750000 4686.8000 54.6566
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 3773.2500 943.3125
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 46.500000 2325.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 105 250.500000 12435.0000 49.6407
CONIP-CONIP-CONSULT, ITDS PHONE 9 11.000000 275.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.750000 237.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 298 1112.500000 54700.7000 49.1692
INTR-T1013-INTERPRETER 2 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1007 4483.000000 45610.0000 10.1740
OCCT-97530-OT SESSION BY LICENSED OT 13 53.000000 3723.3100 70.2511
PHY-97110-PT SESSION BY LICENSED PT 7 29.260000 1999.0300 68.3195
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 89 334.000000 23365.8500 69.9576
TRAV-TRAVS-Travel by mile 7 175.000000 77.8800 0.4450
Subtotal (Total Children Is Unduplicated) 1015 6510.510000 148872.5200 22.8665
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Total 6596.260000 153559.3200 23.2798
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Number of Children (Unduplicated) With at Least One Service 1017
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Center 07
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 3026 6596.260000 153559.3200 153559.3200
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3026 6596.260000 153559.3200 153559.3200