CMS/EIP Fiscal Report Center: 01
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 10.000000 485.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 197 386.750000 19125.0000 49.4505
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 149 215.000000 15628.6200 72.6913
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 219 360.000000 19980.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 63 97.500000 7171.5700 73.5546
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 29.5600 29.5600
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 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 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 514 1092.750000 63866.0500 58.4453
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 103.0600 103.0600
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 59.0000 59.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 185 258.750000 12512.5000 48.3575
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 73 117.250000 5812.5000 49.5736
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 43.7500 21.8750
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 17.000000 850.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 17.000000 850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 69.000000 3450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 438 2890.250000 144337.5000 49.9395
INTR-T1013-INTERPRETER 92 441.500000 21574.2500 48.8658
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1547 12088.00000 120573.5400 9.9746
OCCT-97530-OT SESSION BY LICENSED OT 31 220.250000 14502.5500 65.8459
PHY-97110-PT SESSION BY LICENSED PT 27 161.750000 9559.6100 59.1011
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 91 496.000000 30153.6200 60.7936
TRAV-TRAVS-Travel by mile 946 78575.00000 33173.3300 0.4222
Subtotal (Total Children Is Unduplicated) 1606 95359.75000 397705.2100 4.1706
-----------------------------------------------------------------------------------------------------------------------
Total 96452.500000 461571.2600 4.7855
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1703
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 21718 90548.750000 390335.9100 390151.5900
D 443 1487.250000 11417.2700 0.0000
S 360 1415.750000 15200.0400 0.0000
H 0 0.000000 0.0000 0.0000
T 902 2556.250000 18885.2100 18885.2100
17 68.000000 1346.5800 0.0000
Other 256 376.500000 24386.2500 0.0000
---------------------------------------------------------
Total 23696 96452.500000 461571.2600 409036.8000