CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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 7 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 109 212.750000 10637.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 18 31.500000 2362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 25 40.500000 2247.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 70.500000 5287.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 214 390.750000 22617.2500 57.8816
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 575.2200 287.6100
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 52 58.250000 2912.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 52 64.250000 3212.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 184 184.750000 4618.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 37 57.500000 2875.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 67 108.250000 5412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 16.250000 406.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 6.000000 300.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 11 16.000000 800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 9 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 14.750000 737.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 32 47.750000 2387.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 145 650.750000 32537.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 261 1527.500000 76375.0000 50.0000
INTR-T1013-INTERPRETER 48 253.250000 12662.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 614 3168.000000 31680.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 92.500000 6608.2000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 16 105.500000 7536.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 57.000000 3653.2200 64.0916
PHY-97110GT-PT SESSION BY LICENSED PT 18 173.000000 11769.9300 68.0343
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 101.250000 7233.3000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 381.000000 27078.6400 71.0725
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 79 150.750000 5577.7500 37.0000
TRAV-TRAVS-Travel by mile 315 17455.00000 7646.7000 0.4381
Subtotal (Total Children Is Unduplicated) 1023 24712.75000 255509.8800 10.3392
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Total 25103.500000 278127.1300 11.0792
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Number of Children (Unduplicated) With at Least One Service 1090
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Center 01
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 4283 9974.500000 149819.1000 149819.1000
D 516 1657.250000 12227.1400 0.0000
S 2 3.000000 166.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 4061 13363.000000 108542.8200 108098.2000
12 13.750000 851.8200 0.0000
Other 54 92.000000 6519.7500 0.0000
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Total 8928 25103.500000 278127.1300 257917.3000