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
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 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 17 32.500000 2267.0400 69.7551
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.000000 2053.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 32.000000 2400.0000 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
Subtotal (Total Children Is Unduplicated) 245 474.750000 25555.2900 53.8289
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EI Services,Class #03
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 48 250.250000 12512.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 72.000000 3600.0000 50.0000
INTR-T1013-INTERPRETER 87 420.750000 21037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 845 5912.000000 58548.0100 9.9032
OCCT-97530-OT SESSION BY LICENSED OT 3 15.000000 756.6000 50.4400
PHY-97110-PT SESSION BY LICENSED PT 5 25.000000 1594.6800 63.7872
PHY-97110GT-PT SESSION BY LICENSED PT 1 18.000000 1285.9200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 8.000000 571.5200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 17.000000 1038.5300 61.0900
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) 1017 44624.25000 144578.1000 3.2399
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Total 45099.000000 170133.3900 3.7724
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Number of Children (Unduplicated) With at Least One Service 1071
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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 6732 31117.500000 111098.9700 111098.9700
D 601 3643.000000 9910.7900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2917 10253.000000 47197.2900 47197.2900
17 85.500000 1926.3400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10267 45099.000000 170133.3900 158296.2600