CMS/EIP Fiscal Report Center: 57
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
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 11 12.000000 612.6000 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 14.000000 700.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 88 86.000000 4300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 144 139.000000 6950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.500000 87.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 68.000000 1700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 39 116.000000 5800.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 791 4574.750000 228737.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 35 97.000000 970.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 10 39.000000 2786.1600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.500000 85.8000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 12 37.500000 2679.0000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.500000 85.7400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 6.250000 357.2500 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.500000 107.1600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 57.000000 4072.0800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 27.000000 1544.4000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 117 231.500000 8565.5000 37.0000
Subtotal (Total Children Is Unduplicated) 874 5515.500000 270274.7300 49.0028
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Total 5527.500000 270887.3300 49.0072
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Number of Children (Unduplicated) With at Least One Service 874
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Center 57
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 5 5.500000 242.5000 242.5000
H 0 0.000000 0.0000 0.0000
T 1119 2364.750000 112149.3800 112149.3800
996 3143.750000 157839.9500 157539.9500
Other 10 13.500000 655.5000 655.5000
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Total 2130 5527.500000 270887.3300 270587.3300