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
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 22 36.250000 1812.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.500000 497.7000 66.3600
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 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 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 46 77.250000 4121.1500 53.3482
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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 277 1061.500000 52150.7000 49.1293
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 10 42.000000 2937.4700 69.9398
PHY-97110-PT SESSION BY LICENSED PT 3 9.500000 588.0900 61.9042
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 187.000000 12864.1700 68.7924
TRAV-TRAVS-Travel by mile 7 175.000000 77.8800 0.4450
Subtotal (Total Children Is Unduplicated) 1013 6281.750000 133624.0600 21.2718
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Total 6359.000000 137745.2100 21.6615
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Number of Children (Unduplicated) With at Least One Service 1015
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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 2900 6359.000000 137745.2100 137745.2100
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 2900 6359.000000 137745.2100 137745.2100