CMS/EIP Fiscal Report Center: 07
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 27.7400 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 55.6600 27.8300
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 111.0000 55.5000
EXIT-EXIT-EXIT ASSESSMENT 30 44.000000 2200.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 658.7100 54.8925
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.500000 1082.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 168.3700 56.1233
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 51 89.500000 4475.0400 50.0004
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 72 78.250000 3912.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 111 185.500000 9275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 22.000000 1100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 9 10.000000 500.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 32.250000 1612.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 313 1634.750000 80903.3100 49.4897
INTR-T1013-INTERPRETER 2 14.000000 1066.0000 76.1429
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1168 6780.000000 67870.0000 10.0103
OCCT-97530-OT SESSION BY LICENSED OT 12 48.000000 2830.9200 58.9775
PHY-97110-PT SESSION BY LICENSED PT 3 10.000000 476.4000 47.6400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 36.8800 36.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 42 200.000000 10393.5800 51.9679
TRAV-TRAVS-Travel by mile 18 992.000000 441.4200 0.4450
Subtotal (Total Children Is Unduplicated) 1171 10013.50000 180562.2600 18.0319
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Total 10103.000000 185037.3000 18.3151
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Number of Children (Unduplicated) With at Least One Service 1171
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Center 07
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 3216 10103.000000 185037.3000 184980.7600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3216 10103.000000 185037.3000 184980.7600