CMS/EIP Fiscal Report Center: 55
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
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 5 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 0.933333 70.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.319999 324.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.031733 1652.3800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 26.800000 2010.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 5.272478 269.1600 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 54 97.357543 6352.0400 65.2445
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 1394.2400 199.1771
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 6.000000 300.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 70 68.750000 3437.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 39 91.750000 2293.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 25 25.000000 1250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 21 43.500000 1087.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 63 62.750000 3137.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 23 53.250000 1331.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 19.000000 475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 77 418.250000 20912.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 693 7076.000000 70760.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 296.390273 21174.1300 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 42 251.684451 14396.3200 57.1999
PHY-97110-PT SESSION BY LICENSED PT 30 151.902630 10851.9300 71.4400
PHY-97110HM-PT SESSION BY PT ASST 23 134.106104 7665.5100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 100 582.957100 41646.4001 71.4399
TRAV-TRAVS-Travel by mile 158 9216.000000 4102.3900 0.4451
Subtotal (Total Children Is Unduplicated) 707 18509.29056 206465.9201 11.1547
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Total 18606.648101 212817.9601 11.4377
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Number of Children (Unduplicated) With at Least One Service 720
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Center 55
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 7163 12495.881670 146462.7801 146462.7800
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 3059 6110.766431 66355.1800 66355.1800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10222 18606.648101 212817.9601 212817.9600