CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 5 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 190.1100 47.5275
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 138.000000 10350.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 123 218.500000 16220.6900 74.2366
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 59.000000 3274.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 151.500000 11285.5000 74.4917
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 19.000000 950.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 7 45.000000 2250.0000 50.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 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) 313 659.500000 46036.4500 69.8051
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 152 230.750000 11537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 42 43.750000 1093.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 20 28.500000 1425.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 25.000000 1250.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 27 33.750000 1687.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 36 40.750000 2037.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1224 8777.000000 436220.5600 49.7004
INTR-T1013-INTERPRETER 3 85.000000 3488.0000 41.0353
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 117 796.000000 7960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 124 949.500000 66335.6400 69.8638
PHY-97110-PT SESSION BY LICENSED PT 209 1801.000000 126197.6600 70.0709
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 473 4058.500000 282748.5400 69.6682
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 1647 162011.0000 71484.9300 0.4412
Subtotal (Total Children Is Unduplicated) 1725 178889.5000 1013647.1000 5.6663
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Total 179549.000000 1059683.5500 5.9019
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Number of Children (Unduplicated) With at Least One Service 1847
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Center 09
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 1 1.500000 112.5000 0.0000
P 7287 156703.000000 547196.0000 547196.0000
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 0 0.000000 0.0000 0.0000
3200 22536.500000 489782.0500 0.0000
Other 182 308.000000 22593.0000 0.0000
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Total 10670 179549.000000 1059683.5500 547196.0000