CMS/EIP Fiscal Report Center: 51
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 5 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 79 80.000000 5800.9500 72.5119
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 15.000000 1125.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 5.000000 375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 7.000000 366.2500 52.3214
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 25.000000 1837.5000 73.5000
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 29.000000 1448.7800 49.9579
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 18 19.000000 969.9500 51.0500
Subtotal (Total Children Is Unduplicated) 180 222.000000 14559.0800 65.5814
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 313.8900 156.9450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 6 6.000000 300.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 177 1065.500000 53275.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 9.000000 450.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 566 3527.000000 35153.0000 9.9668
OCCT-97530-OT SESSION BY LICENSED OT 113 448.500000 31340.4900 69.8785
OCCT-97530HM-OT SESSION BY OT ASST 120 553.750000 31617.3000 57.0967
OCCT-97530HMGT-OT SESSION BY OT ASST 3 9.750000 557.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 66 250.750000 17860.0000 71.2263
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 240 1177.750000 83546.1000 70.9370
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 14.500000 978.3200 67.4703
TRAV-TRAVS-Travel by mile 18 3731.000000 1660.2200 0.4450
Subtotal (Total Children Is Unduplicated) 590 10799.50000 257252.0200 23.8207
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Total 11021.500000 271811.1000 24.6619
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Number of Children (Unduplicated) With at Least One Service 642
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Center 51
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 1761 9009.750000 149430.3600 149430.3600
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
666 2010.750000 122305.7400 285.7600
Other 1 1.000000 75.0000 75.0000
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Total 2428 11021.500000 271811.1000 149791.1200