CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 16.000000 1050.0000 65.6250
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 107.500000 7612.5000 70.8140
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 13 26.000000 1950.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 866.8000 50.9882
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 112 206.500000 13856.6000 67.1022
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 101.500000 5075.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 2.250000 56.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 74 114.750000 5737.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 72 212.750000 10637.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 6.000000 300.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 44 62.000000 3100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 5.000000 207.0000 41.4000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 181 1194.500000 59625.0000 49.9163
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 428 3365.000000 33650.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 91 411.000000 29076.0800 70.7447
OCCT-97530HM-OT SESSION BY OT ASST 34 143.500000 8208.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 56 343.250000 22899.9600 66.7151
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 177 1129.000000 78631.1600 69.6467
TRAV-TRAVS-Travel by mile 292 25407.00000 11307.8800 0.4451
Subtotal (Total Children Is Unduplicated) 460 32505.00000 268692.0300 8.2662
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Total 32711.500000 282548.6300 8.6376
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Number of Children (Unduplicated) With at Least One Service 481
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Center 52
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 4 5.000000 260.0000 260.0000
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 3688 30967.250000 179523.6400 179323.6400
785 1739.250000 102764.9900 181.1700
Other 0 0.000000 0.0000 0.0000
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Total 4477 32711.500000 282548.6300 179764.8100