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
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
EXIT-EXIT-EXIT ASSESSMENT 5 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 43 43.000000 3173.9500 73.8128
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 5.000000 375.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 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 4 4.000000 199.7500 49.9375
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 10.500000 750.0000 71.4286
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 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 6 6.000000 306.3000 51.0500
Subtotal (Total Children Is Unduplicated) 94 110.500000 7351.0000 66.5249
-----------------------------------------------------------------------------------------------------------------------
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 47 289.500000 14475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 566 3527.000000 35153.0000 9.9668
OCCT-97530-OT SESSION BY LICENSED OT 29 103.000000 7134.0400 69.2625
OCCT-97530HM-OT SESSION BY OT ASST 39 202.750000 11597.3000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 3 9.750000 557.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 25 93.250000 6608.2000 70.8654
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 81 348.000000 24500.3400 70.4033
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 428.6400 71.4400
TRAV-TRAVS-Travel by mile 18 3731.000000 1660.2200 0.4450
Subtotal (Total Children Is Unduplicated) 574 8324.250000 103028.3300 12.3769
-----------------------------------------------------------------------------------------------------------------------
Total 8434.750000 110379.3300 13.0863
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 600
-----------------------------------------------------------------------------------------------------------------------
Center 51
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 1551 8406.250000 108812.9700 108812.9700
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
15 27.500000 1491.3600 285.7600
Other 1 1.000000 75.0000 75.0000
---------------------------------------------------------
Total 1567 8434.750000 110379.3300 109173.7300