CMS/EIP Fiscal Report Center: 05
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 22.500000 1687.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 65.500000 3635.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 67.000000 5025.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 22.500000 1687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 52 89.500000 4967.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 64.6800 32.3400
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 535.1900 48.6536
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 19 21.000000 944.4100 44.9719
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 161 326.500000 20113.7300 61.6041
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 119 109.500000 5475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 4 4.000000 200.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 105 68.250000 3412.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 1.250000 62.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 1.250000 31.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 33 21.000000 1050.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 12.500000 625.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 70 48.500000 2425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 49.000000 1225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 302 1734.500000 86725.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 31 35.750000 1787.5000 50.0000
INTR-T1013-INTERPRETER 13 71.000000 3550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 732 5220.000000 52200.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 191.000000 12833.5300 67.1913
OCCT-97530GT-OT SESSION BY LICENSED OT 7 13.000000 867.0600 66.6969
PHY-97110-PT SESSION BY LICENSED PT 46 235.500000 14286.6200 60.6651
PHY-97110GT-PT SESSION BY LICENSED PT 6 7.500000 495.8000 66.1067
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 14.3700 14.3700
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 129 610.750000 38650.9100 63.2843
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 16.250000 1062.6800 65.3957
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 16 8.250000 305.2500 37.0000
TRAV-TRAVS-Travel by mile 757 90139.00000 40051.3100 0.4443
Subtotal (Total Children Is Unduplicated) 793 98603.50000 267480.0300 2.7127
-----------------------------------------------------------------------------------------------------------------------
Total 98930.000000 287593.7600 2.9070
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 803
-----------------------------------------------------------------------------------------------------------------------
Center 05
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 8651 98730.750000 284529.6800 284529.6800
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
53 199.250000 3064.0800 3064.0800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8704 98930.000000 287593.7600 287593.7600