CMS/EIP Fiscal Report Center: 09
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
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 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 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 42 74.000000 5550.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 29 56.500000 4237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 87 152.500000 11398.5000 74.7443
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 59.000000 3274.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 88 143.000000 10611.1700 74.2040
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 3.000000 150.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 5 52.000000 2600.0000 50.0000
Subtotal (Total Children Is Unduplicated) 270 564.000000 39432.6700 69.9161
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 351.7400 351.7400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 147 246.750000 12337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 44 41.500000 1037.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 17 22.500000 1125.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 15.000000 750.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 10 19.000000 950.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 28.000000 1400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1227 8594.000000 429505.0100 49.9773
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 79 549.000000 5490.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 137 910.500000 64248.7600 70.5643
OCCT-97530HM-OT SESSION BY OT ASST 2 9.000000 344.5200 38.2800
PHY-97110-PT SESSION BY LICENSED PT 210 1558.000000 109940.8300 70.5654
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 483 4120.750000 292199.9600 70.9094
TRAV-TRAVS-Travel by mile 1643 154573.0000 67465.4700 0.4365
Subtotal (Total Children Is Unduplicated) 1741 170690.5000 987208.7900 5.7836
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Total 171254.500000 1026641.4600 5.9948
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Number of Children (Unduplicated) With at Least One Service 1856
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Center 09
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 7042 157237.500000 523548.3100 523548.3100
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
2854 13691.500000 479382.6500 0.0000
Other 190 325.500000 23710.5000 0.0000
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Total 10086 171254.500000 1026641.4600 523548.3100