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
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 4 8.000000 400.0000 50.0000
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 15 26.500000 1987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 68.000000 5100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 36 55.500000 4162.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 15.000000 750.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 7 30.000000 1500.0000 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 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 106 224.500000 15123.3500 67.3646
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 123 187.000000 9350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 29 31.250000 781.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 18 20.500000 1025.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 17.000000 850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 25.750000 1287.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 31.750000 1587.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 392 2066.000000 103300.0000 50.0000
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 60 337.000000 24075.2800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 101 613.000000 43623.3400 71.1637
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 264 1495.000000 103700.2000 69.3647
TRAV-TRAVS-Travel by mile 1523 117748.0000 51993.0500 0.4416
Subtotal (Total Children Is Unduplicated) 1585 123458.2500 353146.1200 2.8605
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Total 123682.750000 368269.4700 2.9775
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Number of Children (Unduplicated) With at Least One Service 1627
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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 0 0.000000 0.0000 0.0000
P 4889 109217.750000 333602.4900 333602.4900
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
570 14463.500000 34583.7300 0.0000
Other 1 1.500000 83.2500 0.0000
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Total 5460 123682.750000 368269.4700 333602.4900