CMS/EIP Fiscal Report Center: 05
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
EXIT-EXIT-EXIT ASSESSMENT 48 55.250000 2762.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 36 57.500000 4312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 28.500000 2137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 63.500000 3524.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 21.500000 1612.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 160.2600 40.0650
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 108.1500 36.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 816.8000 51.0500
Subtotal (Total Children Is Unduplicated) 159 280.250000 17333.8600 61.8514
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 80 93.750000 4687.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 116 81.500000 4075.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 42 28.250000 1412.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 28 17.500000 875.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 32.750000 1637.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.250000 31.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 82.000000 2050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 214 1339.000000 66950.0000 50.0000
INTR-T1013-INTERPRETER 10 69.000000 3450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 648 4594.000000 45615.1200 9.9293
OCCT-97530-OT SESSION BY LICENSED OT 31 105.500000 6741.2300 63.8979
PHY-97110-PT SESSION BY LICENSED PT 42 139.250000 8430.6500 60.5433
PHY-97110HM-PT SESSION BY PT ASST 2 6.500000 60.8700 9.3646
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 114 539.500000 35480.4600 65.7654
TRAV-TRAVS-Travel by mile 690 71305.00000 31582.6100 0.4429
Subtotal (Total Children Is Unduplicated) 730 78437.75000 213154.6900 2.7175
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Total 78718.000000 230488.5500 2.9280
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Number of Children (Unduplicated) With at Least One Service 743
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Center 05
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 6139 72781.000000 215287.5900 215287.5900
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
532 5937.000000 15200.9600 15200.9600
Other 0 0.000000 0.0000 0.0000
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Total 6671 78718.000000 230488.5500 230488.5500