CMS/EIP Fiscal Report Center: 54
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 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.000000 200.0000 66.6667
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 18.500000 1026.7500 55.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 11 19.000000 1425.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 3.500000 194.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 110 194.000000 10767.0000 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 4 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 147 254.000000 14707.2500 57.9026
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 20.000000 3373.2500 168.6625
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 10.000000 500.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 47 45.500000 2275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 88 43.750000 2187.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 387 350.750000 17537.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.750000 43.7500 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 8 9.000000 450.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 0.250000 12.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 94 210.000000 10500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 466 2995.250000 149763.1600 50.0002
INTR-T1013-INTERPRETER 18 69.750000 1743.7500 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 34 35.000000 350.0000 10.0000
OCCT-97530GT-OT SESSION BY LICENSED OT 8 46.250000 3304.1000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 6.000000 428.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 3.000000 214.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 9 50.000000 3572.0000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 6.000000 428.6400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 74 145.250000 5374.2500 37.0000
TRAV-TRAVS-Travel by mile 33 555.000000 246.9100 0.4449
Subtotal (Total Children Is Unduplicated) 707 4611.250000 202624.0200 43.9412
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Total 4865.250000 217331.2700 44.6701
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Number of Children (Unduplicated) With at Least One Service 761
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Center 54
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 1496 1399.170000 41300.7400 41300.7400
3694 3466.080000 176030.5300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5190 4865.250000 217331.2700 41300.7400