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
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
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 1 1.000000 27.9900 27.9900
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 382.0400 47.7550
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 555.5100 42.7315
Subtotal (Total Children Is Unduplicated) 151 308.500000 19241.6900 62.3718
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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 298 1693.250000 84662.5000 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 27 107.750000 7337.5200 68.0976
OCCT-97530GT-OT SESSION BY LICENSED OT 6 9.000000 581.3000 64.5889
PHY-97110-PT SESSION BY LICENSED PT 40 141.500000 8522.0600 60.2266
PHY-97110GT-PT SESSION BY LICENSED PT 6 7.500000 495.8000 66.1067
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 101 386.000000 23969.4800 62.0971
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 14.250000 949.5800 66.6372
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) 787 98153.25000 239062.3000 2.4356
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Total 98461.750000 258303.9900 2.6234
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Number of Children (Unduplicated) With at Least One Service 796
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Center 05
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 8385 98277.500000 256281.7300 256281.7300
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
44 184.250000 2022.2600 2022.2600
Other 0 0.000000 0.0000 0.0000
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Total 8429 98461.750000 258303.9900 258303.9900