CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 15.000000 727.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 187 371.500000 18462.5000 49.6972
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.000000 1026.7500 54.0395
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 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 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 221 423.000000 21409.5000 50.6135
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 5095.2400 849.2067
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 35.4900 35.4900
AUDE-V5160-DISPENSING FEE BINAURAL 1 2.000000 57.0300 28.5150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 162 217.500000 10337.5000 47.5287
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 104 221.250000 11012.5000 49.7740
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 96.000000 4800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.750000 43.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 71.500000 3550.0000 49.6503
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 68 136.500000 6600.0000 48.3516
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 117 580.750000 28912.5000 49.7848
INTR-T1013-INTERPRETER 94 350.000000 17312.5000 49.4643
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1495 12244.00000 122440.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 53.000000 3786.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 66.000000 4697.1800 71.1694
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 194.000000 13573.6000 69.9670
TRAV-TRAVS-Travel by mile 895 79212.00000 34014.9200 0.4294
Subtotal (Total Children Is Unduplicated) 1572 93459.50000 266456.9400 2.8510
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Total 93882.500000 287866.4400 3.0662
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Number of Children (Unduplicated) With at Least One Service 1577
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Center 01
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 18893 87088.750000 263979.7200 263979.7200
D 340 1357.750000 4743.6500 0.0000
S 109 405.250000 2850.6700 0.0000
H 0 0.000000 0.0000 0.0000
T 1166 4824.750000 15846.4300 15848.2100
19 203.000000 231.6500 0.0000
Other 6 3.000000 214.3200 0.0000
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Total 20533 93882.500000 287866.4400 279827.9300