CMS/EIP Fiscal Report Center: 57
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
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 0.000000 0.0000 0.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 17 21.000000 1119.9500 53.3310
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 13.500000 675.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 123 123.000000 6150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 13 13.000000 650.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 260 259.000000 12950.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 158 1083.000000 54150.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 27.000000 1350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1383 11359.00000 113590.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 29.000000 2071.7600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 9.000000 514.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 59.500000 4250.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 23.000000 1314.6800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 105.500000 7536.9200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 190 190.500000 7048.5000 37.0000
TRAV-TRAVS-Travel by mile 37 11993.00000 5336.7300 0.4450
Subtotal (Total Children Is Unduplicated) 1404 25297.00000 218031.9500 8.6189
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Total 25318.000000 219151.9000 8.6560
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Number of Children (Unduplicated) With at Least One Service 1409
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Center 57
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 275 468.000000 9917.0400 9917.0400
H 0 0.000000 0.0000 0.0000
T 5123 24850.000000 209234.8600 209234.8600
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5398 25318.000000 219151.9000 219151.9000