CMS/EIP Fiscal Report Center: 52
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-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 4 6.000000 362.0500 60.3417
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 13.250000 662.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 67 84.750000 4237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 61 62.500000 1562.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 33 42.500000 2125.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 77 139.250000 6962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 28 23.500000 1175.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 59 89.000000 4450.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 1.750000 43.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 14 12.500000 625.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.000000 75.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 7 6.500000 325.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 22 22.750000 1137.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 22.000000 1100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 10 37.500000 1875.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 286 798.000000 7980.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.500000 250.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 357.2000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 19.500000 1393.0800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 10 8.750000 323.7500 37.0000
TRAV-TRAVS-Travel by mile 215 6843.000000 3044.5000 0.4449
Subtotal (Total Children Is Unduplicated) 400 8256.750000 40453.9500 4.8995
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Total 8262.750000 40816.0000 4.9398
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Number of Children (Unduplicated) With at Least One Service 400
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Center 52
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1407 8257.500000 40717.2500 40721.7000
4 5.250000 98.7500 92.5000
Other 0 0.000000 0.0000 0.0000
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Total 1411 8262.750000 40816.0000 40814.2000