CMS/EIP Fiscal Report Center: 03
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 2 2.000000 97.0000 48.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 165.8600 41.4650
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 10.2100 10.2100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 178.0700 35.6140
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 6.000000 265.4700 44.2450
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 27 29.000000 1278.1600 44.0745
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 227.2000 227.2000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 174 221.000000 11050.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 277 464.250000 23212.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 104 185.500000 9275.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 92 163.250000 8162.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 187 288.500000 14425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 201 977.000000 48850.0000 50.0000
INTR-T1013-INTERPRETER 4 22.250000 1057.7500 47.5393
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 165 825.000000 8250.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 112.250000 6315.5800 56.2635
PHY-97110-PT SESSION BY LICENSED PT 27 136.000000 9206.7500 67.6967
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 158.250000 10067.2700 63.6162
TRAV-TRAVS-Travel by mile 625 69028.00000 30708.7900 0.4449
Subtotal (Total Children Is Unduplicated) 679 72586.00000 180902.0900 2.4922
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Total 72615.000000 182180.2500 2.5089
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Number of Children (Unduplicated) With at Least One Service 679
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Center 03
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 2779 27083.000000 68873.2300 68873.2300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 329 2999.750000 7473.5200 7473.5200
T 835 7246.500000 18192.7500 18192.7500
3529 35285.750000 87640.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7472 72615.000000 182180.2500 94539.5000