CMS/EIP Fiscal Report Center: 03
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 2 2.000000 97.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 16 16.000000 810.6500 50.6656
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 166 191.500000 9575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 239 395.250000 19693.7500 49.8261
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 87 147.000000 7350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 56 102.250000 5112.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 132 190.000000 9500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 184 860.250000 42172.5000 49.0235
INTR-T1013-INTERPRETER 9 58.750000 2888.7500 49.1702
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 154 678.000000 6780.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 43.000000 3071.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 98.500000 7036.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 121.000000 8596.7400 71.0474
TRAV-TRAVS-Travel by mile 605 61440.00000 27317.6800 0.4446
Subtotal (Total Children Is Unduplicated) 652 64334.50000 149320.6800 2.3210
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Total 64350.500000 150131.3300 2.3330
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Number of Children (Unduplicated) With at Least One Service 652
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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 3731 38174.500000 87975.2100 87975.2100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 207 1458.500000 3546.3100 3546.3100
T 0 0.000000 0.0000 0.0000
2526 24717.500000 58609.8100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6464 64350.500000 150131.3300 91521.5200