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
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 10.000000 485.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 197 386.750000 19125.0000 49.4505
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 31.500000 2199.7600 69.8337
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 50.000000 2775.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 12.500000 796.5700 63.7256
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 242 491.750000 25432.3800 51.7181
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EI Services,Class #03
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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 106 594.000000 29675.0000 49.9579
INTR-T1013-INTERPRETER 92 438.500000 21424.2500 48.8580
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1547 12088.00000 120573.5400 9.9746
OCCT-97530-OT SESSION BY LICENSED OT 7 38.000000 2391.6100 62.9371
PHY-97110-PT SESSION BY LICENSED PT 12 61.500000 3939.5800 64.0582
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 101.500000 6346.6900 62.5290
TRAV-TRAVS-Travel by mile 946 78575.00000 33173.3300 0.4222
Subtotal (Total Children Is Unduplicated) 1598 92379.50000 241092.7500 2.6098
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Total 92871.250000 266525.1300 2.8698
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Number of Children (Unduplicated) With at Least One Service 1613
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Center 01
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 19004 87810.000000 246190.3900 246006.0700
D 285 1326.750000 3427.2100 0.0000
S 201 1228.250000 3499.4400 0.0000
H 0 0.000000 0.0000 0.0000
T 779 2439.250000 12136.5100 12136.5100
16 67.000000 1271.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 20285 92871.250000 266525.1300 258142.5800