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
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
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 16 22.000000 1123.1000 51.0500
-----------------------------------------------------------------------------------------------------------------------
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 14 15.000000 750.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 306 307.000000 15350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 141 1108.000000 55400.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1318 11696.00000 116960.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 47.000000 3357.6800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 12 58.000000 4143.5200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 12.000000 685.9200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 128.000000 9144.3200 71.4400
TRAV-TRAVS-Travel by mile 37 10833.00000 4820.5600 0.4450
Subtotal (Total Children Is Unduplicated) 1332 24287.00000 214762.0000 8.8427
-----------------------------------------------------------------------------------------------------------------------
Total 24309.000000 215885.1000 8.8809
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1340
-----------------------------------------------------------------------------------------------------------------------
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 72 37.500000 2617.8300 2617.8300
H 0 0.000000 0.0000 0.0000
T 4648 24251.500000 213067.2700 212977.3300
5 13.000000 130.0000 130.0000
Other 1 7.000000 70.0000 70.0000
---------------------------------------------------------
Total 4726 24309.000000 215885.1000 215795.1600