CMS/EIP Fiscal Report Center: 03
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 8 8.000000 405.8500 50.7313
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 722.0000 722.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 163 190.250000 9512.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 151 203.500000 10175.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 2.750000 137.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 97 157.250000 7862.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 48 77.750000 3887.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 105 149.000000 7450.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 4 4.000000 200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 198 901.250000 45062.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 51 79.000000 3950.0000 50.0000
INTR-T1013-INTERPRETER 8 65.500000 3098.2400 47.3014
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 161 766.000000 7640.0000 9.9739
OCCT-97530-OT SESSION BY LICENSED OT 14 69.250000 4947.2200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 24 91.500000 6123.1600 66.9198
PHY-97110GT-PT SESSION BY LICENSED PT 4 5.000000 357.2000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 83.000000 5753.6300 69.3208
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.000000 500.0800 71.4400
TRAV-TRAVS-Travel by mile 633 56460.00000 25098.5100 0.4445
Subtotal (Total Children Is Unduplicated) 673 59324.50000 142986.4800 2.4102
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Total 59332.500000 143392.3300 2.4168
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Number of Children (Unduplicated) With at Least One Service 673
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Center 03
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 2424 23277.750000 53119.6900 53119.6900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 234 2105.000000 5651.0200 5651.0200
T 0 0.000000 0.0000 0.0000
3561 33949.750000 84621.6200 115.7000
Other 0 0.000000 0.0000 0.0000
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Total 6219 59332.500000 143392.3300 58886.4100