CMS/EIP Fiscal Report Center: 57
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
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 29 29.000000 1480.4500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 10 11.000000 561.5500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 22 23.000000 1174.1500 51.0500
Subtotal (Total Children Is Unduplicated) 52 91.500000 5178.1500 56.5918
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 79 79.000000 3950.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 16.000000 800.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 316 317.000000 15850.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 914.000000 22850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1313 11151.00000 557550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1321 11795.00000 117950.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 146.750000 10483.8200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 37 166.000000 11859.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 15 103.000000 5887.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 326.000000 23253.7200 71.3304
TRAV-TRAVS-Travel by mile 37 10833.00000 4820.5600 0.4450
Subtotal (Total Children Is Unduplicated) 1361 35850.75000 775454.6200 21.6301
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Total 35942.250000 780632.7700 21.7191
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Number of Children (Unduplicated) With at Least One Service 1371
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Center 57
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 161 87.500000 6230.6100 6230.6100
D 0 0.000000 0.0000 0.0000
S 107 58.000000 4021.1800 4021.1800
H 0 0.000000 0.0000 0.0000
T 5559 27463.000000 373920.5100 373830.5700
2256 8178.250000 392720.7400 392166.5710
Other 101 155.500000 3739.7300 3739.7300
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Total 8184 35942.250000 780632.7700 779988.6610