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
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
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 26.500000 1987.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 60.000000 4500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 16 27.000000 1498.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 25.000000 1875.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 4 30.000000 1500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 93 199.000000 13498.5000 67.8317
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 137 232.000000 11600.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 41 38.500000 962.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 19.500000 975.0000 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 389 2164.000000 108200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 78 546.000000 5460.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 61 297.000000 21217.6800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 82 425.500000 30397.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 198 1309.000000 93514.9600 71.4400
TRAV-TRAVS-Travel by mile 1375 104756.0000 45784.0600 0.4371
Subtotal (Total Children Is Unduplicated) 1452 109852.0000 321274.4200 2.9246
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Total 110051.000000 334772.9200 3.0420
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Number of Children (Unduplicated) With at Least One Service 1503
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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 4472 104418.500000 316409.4500 316409.4500
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
263 5623.000000 17650.9700 0.0000
Other 6 9.500000 712.5000 0.0000
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Total 4741 110051.000000 334772.9200 316409.4500