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:OTHER
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 1 2.000000 100.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 18 41.000000 2526.0500 61.6110
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 43.750000 2187.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 5 8.000000 400.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 8.000000 400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 9.000000 450.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 236 1098.000000 52570.5600 47.8785
OCCT-97530-OT SESSION BY LICENSED OT 33 138.000000 9858.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 57 251.000000 17931.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 186 1212.000000 85982.1000 70.9423
TRAV-TRAVS-Travel by mile 775 44263.00000 19491.8800 0.4404
Subtotal (Total Children Is Unduplicated) 828 47051.25000 189984.7000 4.0378
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Total 47092.250000 192510.7500 4.0879
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Number of Children (Unduplicated) With at Least One Service 835
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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 2229 47056.250000 190367.7100 190367.7100
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
13 36.000000 2143.0400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2242 47092.250000 192510.7500 190367.7100