CMS/EIP Fiscal Report Center: 51
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
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 24 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 3.000000 225.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 33 33.000000 2403.1500 72.8227
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 62.0400 62.0400
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 6.2500 6.2500
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.750000 18.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 12.5000 6.2500
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 163.000000 800.0000 4.9080
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 23 65.250000 3112.5000 47.7011
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 71 227.000000 2270.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 8.000000 571.5200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 8.000000 457.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 5 25.000000 1430.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 3 7.500000 535.8000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 11 25.250000 1768.1400 70.0253
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 63.250000 4518.5800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 49 163.250000 11624.3300 71.2057
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 149 762.000000 27265.7600 35.7818
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Total 795.000000 29668.9100 37.3194
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Number of Children (Unduplicated) With at Least One Service 178
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Center 51
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 238 776.000000 28333.9100 28333.9100
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 0 0.000000 0.0000 0.0000
19 19.000000 1335.0000 10.0000
Other 0 0.000000 0.0000 0.0000
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Total 257 795.000000 29668.9100 28343.9100