CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 23 24.500000 1225.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 39.000000 2925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 90.1000 45.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 51 100.000000 6444.6000 64.4460
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 6.000000 1482.0800 247.0133
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 30.750000 1537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 111 87.000000 4337.5000 49.8563
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 5.750000 250.0000 43.4783
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 7.500000 375.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 58 50.750000 2537.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.500000 25.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 559.750000 27987.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 38.000000 1900.0000 50.0000
INTR-T1013-INTERPRETER 22 66.250000 3312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 469 2534.000000 25340.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 110.000000 7848.4000 71.3491
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 26 115.000000 8047.8700 69.9815
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 40 192.500000 13752.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 7.250000 517.9400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 2.250000 83.2500 37.0000
TRAV-TRAVS-Travel by mile 171 13837.00000 6156.1000 0.4449
Subtotal (Total Children Is Unduplicated) 559 17658.00000 105755.5300 5.9891
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Total 17758.000000 112200.1300 6.3183
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Number of Children (Unduplicated) With at Least One Service 559
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Center 02
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 3 3.000000 100.0000 100.0000
H 0 0.000000 0.0000 0.0000
T 4540 17489.500000 108988.5800 108975.1400
100 265.500000 3111.5500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4643 17758.000000 112200.1300 109075.1400