CMS/EIP Fiscal Report Center: 55
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
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 9 18.000000 900.0000 50.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 3.333333 250.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.140059 58.2000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 1.706170 87.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 25 42.179562 2302.4000 54.5857
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 2.250000 112.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 31 32.750000 1637.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 60 64.500000 1612.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 33.000000 1650.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 10 16.000000 800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 43 73.500000 1837.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 25 28.000000 1400.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 40 34.000000 850.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 52 267.500000 13375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 50 270.250000 13512.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 425 2654.000000 26540.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 32.611561 2329.7700 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 10.935890 781.2600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 5 11.242832 643.0900 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 6 22.409790 1281.8400 57.2000
PHY-97110-PT SESSION BY LICENSED PT 3 7.000000 500.0800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 9.236282 659.8400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 4 16.000000 914.5600 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 8.572078 489.9800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 110.854140 7919.4200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 46.661954 3333.5300 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 4 19.500000 721.5000 37.0000
TRAV-TRAVS-Travel by mile 51 2800.000000 1245.7500 0.4449
Subtotal (Total Children Is Unduplicated) 523 6575.774527 84360.6200 12.8290
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Total 6617.954089 86663.0200 13.0951
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Number of Children (Unduplicated) With at Least One Service 527
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Center 55
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 3032 4857.023121 64980.7300 64980.7300
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
1135 1760.930968 21682.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4167 6617.954089 86663.0200 64980.7300