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
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
EVAL-96111-DEVELOPMENTAL EVALUATION 6 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 9 16.000000 800.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 7 8.767199 657.5400 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 39.582000 2968.6500 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 13 25.870934 1940.3200 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 0.118511 6.0500 51.0501
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 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 3 2.510284 128.1500 51.0500
Subtotal (Total Children Is Unduplicated) 63 128.848928 8403.9100 65.2230
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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 79 87.750000 4387.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 86 109.500000 2737.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 56 98.000000 4900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 64 156.500000 3912.5000 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 54 60.000000 3000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 47 38.000000 950.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 25.500000 637.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 100 638.750000 31937.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 6.000000 300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 822 7094.000000 70940.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 112.785132 8057.3700 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 22 90.737417 5190.1800 57.2000
PHY-97110-PT SESSION BY LICENSED PT 9 21.671752 1548.2300 71.4400
PHY-97110HM-PT SESSION BY PT ASST 7 29.038665 1659.8500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 185.055441 13220.3600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 2.750000 196.4600 71.4400
TRAV-TRAVS-Travel by mile 122 5627.000000 2503.2700 0.4449
Subtotal (Total Children Is Unduplicated) 836 14393.28841 157026.8200 10.9097
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Total 14522.137335 165430.7300 11.3916
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Number of Children (Unduplicated) With at Least One Service 849
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Center 55
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 7172 11257.718622 125989.1200 125989.1200
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 459 639.000000 6936.7100 6936.7100
1814 2625.418713 32504.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9445 14522.137335 165430.7300 132925.8300