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
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 8 8.000000 388.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 160 316.750000 15537.5000 49.0529
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 43.000000 3225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 44 71.000000 3919.6900 55.2069
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 19.500000 1462.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 227 459.250000 24583.7400 53.5302
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 793.6800 396.8400
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 115 618.500000 30912.5000 49.9798
INTR-T1013-INTERPRETER 91 359.000000 17462.5000 48.6421
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1579 11415.00000 113997.0800 9.9866
OCCT-97530-OT SESSION BY LICENSED OT 3 8.000000 571.5200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 59.000000 3812.7200 64.6224
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 66.500000 4117.8400 61.9224
TRAV-TRAVS-Travel by mile 989 78304.00000 33209.1000 0.4241
Subtotal (Total Children Is Unduplicated) 1636 91332.75000 227495.6900 2.4908
-----------------------------------------------------------------------------------------------------------------------
Total 91792.000000 252079.4300 2.7462
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1661
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 18719 88256.250000 237191.0400 237191.0400
D 137 728.000000 1767.1500 0.0000
S 216 1650.000000 4175.1500 0.0000
H 0 0.000000 0.0000 0.0000
T 360 1103.750000 6234.6400 6234.6400
27 54.000000 2711.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19459 91792.000000 252079.4300 243425.6800