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
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 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 36.000000 1998.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 2.500000 187.5000 75.0000
Subtotal (Total Children Is Unduplicated) 31 50.000000 2913.0000 58.2600
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 18.000000 2346.4900 130.3606
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 6 13.000000 650.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 73 482.000000 24100.0000 50.0000
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 1 10.000000 714.4000 71.4400
PHY-97110GT-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) 531 1803.750000 59279.4400 32.8646
-----------------------------------------------------------------------------------------------------------------------
Total 1853.750000 62192.4400 33.5495
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 543
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1356 1260.000000 32950.3500 32950.3500
868 593.750000 29242.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2224 1853.750000 62192.4400 32950.3500