CMS/EIP Fiscal Report Center: 02
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 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 11 17.000000 850.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 286.3000 47.7167
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 30 43.500000 2464.6000 56.6575
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 498.9800 249.4900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 31.500000 1575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 18 20.000000 1000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 34 27.000000 1350.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 24 26.250000 1312.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.250000 31.2500 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 4.250000 212.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 8.500000 425.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 21 20.500000 1025.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 59 364.000000 18200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 38 173.500000 8675.0000 50.0000
INTR-T1013-INTERPRETER 14 79.250000 3962.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 239 1412.000000 14120.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 45.000000 3214.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 8 38.000000 2714.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 83.750000 5603.5500 66.9081
PHY-97110GT-PT SESSION BY LICENSED PT 2 6.000000 272.7800 45.4633
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 157.500000 11044.0400 70.1209
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 16 81.000000 5786.6400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 5 3.500000 129.5000 37.0000
TRAV-TRAVS-Travel by mile 57 5201.000000 2313.8500 0.4449
Subtotal (Total Children Is Unduplicated) 334 7788.500000 83536.3600 10.7256
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Total 7832.000000 86000.9600 10.9807
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Number of Children (Unduplicated) With at Least One Service 338
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Center 02
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2622 7518.750000 77076.0600 76805.2800
345 313.250000 8924.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2967 7832.000000 86000.9600 76805.2800