CMS/EIP Fiscal Report Center: 52
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
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 70.4000 70.4000
EXIT-EXIT-EXIT ASSESSMENT 3 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 68.500000 5137.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 145.500000 8075.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 20.000000 1500.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 4.000000 153.1500 38.2875
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 145 311.000000 19251.4500 61.9018
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 80 82.250000 4112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 86 122.750000 6137.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 91 224.500000 11225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 13.000000 650.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 28.500000 1425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 225 1243.500000 61475.0000 49.4371
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 528 3523.000000 35230.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 80 342.000000 24075.2800 70.3956
OCCT-97530HM-OT SESSION BY OT ASST 44 291.500000 16559.4000 56.8075
PHY-97110-PT SESSION BY LICENSED PT 72 398.750000 27604.4000 69.2273
PHY-97110HM-PT SESSION BY PT ASST 5 20.000000 1143.2000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 162 949.500000 64474.6400 67.9038
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.750000 52.0500 13.8800
TRAV-TRAVS-Travel by mile 386 27688.00000 12319.0200 0.4449
Subtotal (Total Children Is Unduplicated) 566 34936.50000 266620.4900 7.6316
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Total 35247.500000 285871.9400 8.1104
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Number of Children (Unduplicated) With at Least One Service 587
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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 1 0.250000 12.5000 12.5000
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 3818 32567.250000 129065.6000 129065.6000
1274 2680.000000 156793.8400 196.0200
Other 0 0.000000 0.0000 0.0000
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Total 5093 35247.500000 285871.9400 129274.1200