CMS/EIP Fiscal Report Center: 55
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
EVAL-96111-DEVELOPMENTAL EVALUATION 7 16.000000 800.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 9 16.000000 800.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 80.393331 6029.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 115 228.736533 17155.2400 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 46 91.870934 6890.3200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 37 74.000000 4107.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 8 8.000000 408.4000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 32 32.000000 1633.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 24.000000 1225.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 272 598.000798 40721.8000 68.0966
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 523.6000 523.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 6.750000 337.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 87 96.750000 4837.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 113 144.000000 3600.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 56 98.000000 4900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 65 161.500000 4037.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 62 68.000000 3400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 71 60.000000 1500.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 42.000000 1050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 448 3207.250000 160362.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 15.000000 750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 823 7105.000000 71050.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 123 827.435890 59112.0200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 166 990.137065 56635.8400 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 9 12.000000 686.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 53 339.010079 24218.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 5.500000 392.9200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 52 338.221486 19332.7400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 250 1588.596009 113489.2986 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 8.750000 625.1000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 122 5627.000000 2503.2700 0.4449
Subtotal (Total Children Is Unduplicated) 850 20750.40053 533630.9686 25.7167
-----------------------------------------------------------------------------------------------------------------------
Total 21348.401327 574352.7686 26.9038
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 927
-----------------------------------------------------------------------------------------------------------------------
Center 55
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 7776 11851.968622 165979.5600 165979.5600
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 479 658.500000 8022.9900 8022.9900
8068 8837.932705 400350.2186 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16323 21348.401327 574352.7686 174002.5500