CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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 4 4.000000 194.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 173 343.250000 17162.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 9.500000 527.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 62 117.000000 8604.5400 73.5431
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 47.500000 2636.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 69 114.000000 6327.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 101.000000 7575.0000 75.0000
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 3.000000 150.0000 50.0000
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 3.000000 150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 411 761.750000 44669.2900 58.6404
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1205.9200 1205.9200
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 59 64.500000 3225.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 92 116.500000 5825.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 37 32.750000 818.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 37 62.000000 3100.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 71 114.250000 5712.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 8.250000 206.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 27.000000 1350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 10 16.500000 825.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.750000 68.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 22.000000 1100.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 6 6.000000 300.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 15 21.000000 1050.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 29 49.500000 2475.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.500000 87.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 231 1469.250000 73462.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 105 440.000000 22000.0000 50.0000
INTR-T1013-INTERPRETER 89 424.250000 21212.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 845 5912.000000 58548.0100 9.9032
OCCT-97530-OT SESSION BY LICENSED OT 11 58.000000 3153.5200 54.3710
OCCT-97530GT-OT SESSION BY LICENSED OT 1 13.000000 928.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 20 106.000000 7095.3500 66.9373
PHY-97110GT-PT SESSION BY LICENSED PT 4 38.000000 2714.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 178.250000 12268.8800 68.8296
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 176.250000 12415.3500 70.4417
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 30 38.750000 1433.7200 36.9992
TRAV-TRAVS-Travel by mile 450 37300.00000 16030.3700 0.4298
Subtotal (Total Children Is Unduplicated) 1049 46702.25000 258638.3100 5.5380
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Total 47464.000000 303307.6000 6.3903
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Number of Children (Unduplicated) With at Least One Service 1193
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Center 01
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 8085 32462.500000 185139.7600 185139.7600
D 785 3827.500000 19675.7900 0.0000
S 1 1.500000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 3520 10853.500000 80744.4600 79478.1300
17 85.500000 1926.3400 0.0000
Other 137 233.500000 15738.0000 0.0000
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Total 12545 47464.000000 303307.6000 264617.8900