CMS/EIP Fiscal Report Center: 03
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
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4 4.000000 204.2000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 42.250000 2112.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 113 152.750000 7637.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 8.000000 200.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 38.000000 1900.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 43 51.750000 2587.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 21.750000 1087.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 39 51.750000 2587.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 33.500000 1675.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 11 18.750000 937.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 27 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 64 101.750000 5087.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 87 318.500000 15925.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 131 598.250000 29912.5000 50.0000
INTR-T1013-INTERPRETER 2 22.750000 1112.5000 48.9011
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 61 205.000000 2050.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 13.000000 928.7200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 31.000000 2214.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 9 25.750000 1839.5800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 20.000000 1366.9800 68.3490
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 17.500000 1164.3400 66.5337
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1500.2400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 16 18.750000 693.7500 37.0000
TRAV-TRAVS-Travel by mile 207 14239.00000 6334.7100 0.4449
Subtotal (Total Children Is Unduplicated) 437 16085.25000 92542.9600 5.7533
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Total 16089.250000 92747.1600 5.7645
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Number of Children (Unduplicated) With at Least One Service 437
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Center 03
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 364 1743.000000 13408.7400 13408.7400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 83 937.500000 3019.8000 3019.8000
T 0 0.000000 0.0000 0.0000
2204 13408.750000 76318.6200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2651 16089.250000 92747.1600 16428.5400