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
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 109 212.750000 10637.5000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 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 6 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 132 254.250000 13292.3500 52.2806
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 502.4600 502.4600
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 37 131.000000 6550.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 72 432.000000 21600.0000 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
PHY-97110-PT SESSION BY LICENSED PT 8 32.000000 1867.2200 58.3506
PHY-97110GT-PT SESSION BY LICENSED PT 7 35.000000 2213.9800 63.2566
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 16.000000 1143.0400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 46.750000 3269.8200 69.9427
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) 931 22316.00000 119288.4700 5.3454
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Total 22570.250000 132580.8200 5.8741
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Number of Children (Unduplicated) With at Least One Service 946
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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 2816 8549.000000 69495.1600 69495.1600
D 383 1525.000000 5225.9100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3171 12488.250000 57359.7500 57384.7500
6 8.000000 500.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6376 22570.250000 132580.8200 126879.9100