CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 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 2 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 32.000000 1776.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 25.500000 1912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 67 108.500000 6021.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 57.500000 4312.5000 75.0000
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 121 250.000000 15935.2500 63.7410
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 872.9400 218.2350
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 13.500000 675.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 248 299.000000 14950.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 386 2303.500000 115175.0000 50.0000
INTR-T1013-INTERPRETER 3 10.000000 620.0000 62.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3444.000000 34440.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 108.459991 7748.3814 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 12.000000 686.4000 57.2000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 31.000000 2214.6400 71.4400
TRAV-TRAVS-Travel by mile 509 53688.00000 23897.2100 0.4451
Subtotal (Total Children Is Unduplicated) 572 59921.70999 201485.8214 3.3625
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Total 60171.709991 217421.0714 3.6133
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Number of Children (Unduplicated) With at Least One Service 572
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Center 53
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 1 1.000000 75.0000 75.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2643 20318.851483 36395.3500 36395.3500
T 2085 13253.000000 26561.3300 26561.3300
4802 26589.858508 153889.3914 0.0000
Other 8 9.000000 500.0000 0.0000
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Total 9539 60171.709991 217421.0714 63031.6800