CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 51 105.500000 7612.5000 72.1564
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 102.500000 7687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 16 31.500000 2362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 70.000000 3885.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 20.000000 1350.0000 67.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 612.6000 51.0500
Subtotal (Total Children Is Unduplicated) 175 401.500000 27335.0500 68.0823
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 94 105.750000 5287.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 56 96.750000 4837.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 10.500000 262.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 74 126.750000 6337.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 22.500000 1125.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 26.000000 1300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 162 952.750000 47337.5000 49.6851
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 469 3450.000000 34480.0000 9.9942
OCCT-97530-OT SESSION BY LICENSED OT 106 423.000000 29397.5600 69.4978
OCCT-97530HM-OT SESSION BY OT ASST 45 298.000000 16816.8000 56.4322
PHY-97110-PT SESSION BY LICENSED PT 62 383.750000 26457.8200 68.9455
PHY-97110HM-PT SESSION BY PT ASST 3 15.750000 900.2700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 169 1117.750000 75075.4800 67.1666
TRAV-TRAVS-Travel by mile 282 24956.00000 11107.0000 0.4451
Subtotal (Total Children Is Unduplicated) 488 31989.00000 260816.1800 8.1533
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Total 32390.500000 288151.2300 8.8962
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Number of Children (Unduplicated) With at Least One Service 558
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Center 52
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 3 55.250000 78.5000 78.5000
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 3651 30383.750000 173124.2200 173129.2200
902 1951.500000 114948.5100 219.1400
Other 0 0.000000 0.0000 0.0000
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Total 4556 32390.500000 288151.2300 173426.8600