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
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 2 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 9.500000 527.2500 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 23 43.000000 2746.0000 63.8605
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 510.3900 170.1300
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 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 45 239.439000 11971.9500 50.0000
INTR-T1013-INTERPRETER 2 9.000000 570.0000 63.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3443.000000 34430.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 16.036813 1145.6700 71.4400
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 57748.22581 90521.1100 1.5675
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Total 57791.225813 93267.1100 1.6139
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2611 20286.851483 34345.1100 34345.1100
T 2071 13239.000000 25625.4900 25625.4900
2544 24265.374330 33296.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7226 57791.225813 93267.1100 59970.6000