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:TPIN
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 1 2.000000 100.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 21.626132 1621.9600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 43.154533 3236.5900 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.881489 96.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 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 9 8.489716 433.4000 51.0500
Subtotal (Total Children Is Unduplicated) 60 110.151870 7651.6500 69.4645
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 9.000000 450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 54 34.500000 862.5000 25.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 8 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 30 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 23 127.000000 6350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7 11.000000 110.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 191.150758 13655.8100 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 50 280.399648 16038.8600 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 6 7.000000 400.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 17 93.588327 6685.9500 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 2.500000 178.6000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 15 99.182821 5669.2900 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 93 566.880434 40497.9386 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 3.000000 214.3200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 244 1463.201988 92345.4286 63.1119
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Total 1573.353858 99997.0786 63.5566
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Number of Children (Unduplicated) With at Least One Service 268
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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 545 532.250000 35778.6800 35778.6800
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 20 19.500000 1086.2800 1086.2800
1135 1021.603858 63132.1186 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1700 1573.353858 99997.0786 36864.9600