CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 8 8.000000 388.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 160 316.750000 15537.5000 49.0529
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 136 216.500000 15817.4300 73.0597
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 236 386.500000 21349.9400 55.2392
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 99.500000 7462.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 10.5500 10.5500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 476 1047.750000 61820.9200 59.0035
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 2503.8400 500.7680
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 173 232.500000 11437.5000 49.1935
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 5.750000 125.0000 21.7391
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 62 114.250000 5662.5000 49.5624
CONIP-CONIP-CONSULT, ITDS PHONE 11 15.500000 375.0000 24.1935
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 23.000000 1150.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 31.2500 15.6250
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 44.000000 700.0000 15.9091
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 37 61.750000 3087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 442 2750.250000 137433.9400 49.9714
INTR-T1013-INTERPRETER 92 363.500000 17687.5000 48.6589
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1579 11415.00000 113997.0800 9.9866
OCCT-97530-OT SESSION BY LICENSED OT 21 157.500000 10781.7500 68.4556
PHY-97110-PT SESSION BY LICENSED PT 28 147.000000 9118.1800 62.0284
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 75 427.250000 26005.4800 60.8671
TRAV-TRAVS-Travel by mile 989 78304.00000 33209.1000 0.4241
Subtotal (Total Children Is Unduplicated) 1646 94070.25000 373355.6200 3.9689
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Total 95118.000000 435176.5400 4.5751
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Number of Children (Unduplicated) With at Least One Service 1747
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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 21252 90795.250000 372363.8100 372363.8100
D 254 846.500000 7908.5000 0.0000
S 284 1725.500000 8493.0200 0.0000
H 0 0.000000 0.0000 0.0000
T 463 1204.750000 12191.5100 12191.5100
28 55.500000 2823.9500 0.0000
Other 305 490.500000 31395.7500 0.0000
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Total 22586 95118.000000 435176.5400 384555.3200