CMS/EIP Fiscal Report Center: 54
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 3 3.000000 145.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 12 16.000000 800.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 20.500000 1137.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 9.000000 675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 94 149.500000 8297.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 18.500000 1387.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.000000 75.0000 75.0000
Subtotal (Total Children Is Unduplicated) 164 254.500000 14883.5000 58.4813
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 8 21.000000 2710.5700 129.0748
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 38 44.500000 2225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 0.500000 25.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 478 421.000000 21050.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 78 26.500000 1325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 14 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 616 4203.000000 200212.5000 47.6356
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 81 107.750000 5387.5000 50.0000
INTR-T1013-INTERPRETER 20 74.000000 1850.0000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 757 4417.000000 44170.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 51.000000 3643.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.750000 125.0200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 15 53.000000 3786.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 52.250000 3732.7400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 38 33.000000 1221.0000 37.0000
TRAV-TRAVS-Travel by mile 803 69067.00000 30699.3000 0.4445
Subtotal (Total Children Is Unduplicated) 913 78587.50000 322737.1600 4.1067
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Total 78842.000000 337620.6600 4.2822
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Number of Children (Unduplicated) With at Least One Service 916
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Center 54
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 1 1.000000 50.0000 9.2500
D 1 1.000000 55.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9055 55451.380000 118752.4200 118752.4200
6064 23388.620000 218762.7400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15121 78842.000000 337620.6600 118761.6700