CMS/EIP Fiscal Report Center: 05
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.500000 862.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 42.000000 2331.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 39 59.500000 4462.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 23.000000 1725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 67.500000 3746.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 1.000000 50.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 112.5500 37.5167
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 122.3400 30.5850
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 129 247.500000 15704.9900 63.4545
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 95 105.250000 5113.8300 48.5875
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 83 62.000000 3100.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 11 4.500000 112.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 17.500000 875.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 15.500000 775.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 47 33.250000 1662.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 2.250000 56.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 65.500000 1637.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 254 1367.250000 68362.5000 50.0000
INTR-T1013-INTERPRETER 14 66.000000 3300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 690 4562.000000 45620.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 30 181.250000 10788.2400 59.5213
PHY-97110-PT SESSION BY LICENSED PT 32 157.500000 8178.7800 51.9288
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 95 425.000000 26887.5300 63.2648
TRAV-TRAVS-Travel by mile 718 69566.00000 30942.7700 0.4448
Subtotal (Total Children Is Unduplicated) 743 76633.50000 207481.1500 2.7074
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Total 76881.000000 223186.1400 2.9030
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Number of Children (Unduplicated) With at Least One Service 754
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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 6317 69086.250000 202797.5300 202797.5300
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
734 7794.750000 20388.6100 20388.6100
Other 0 0.000000 0.0000 0.0000
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Total 7051 76881.000000 223186.1400 223186.1400