CMS/EIP Fiscal Report Center: 03
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 2 2.000000 97.0000 48.5000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 1.500000 83.2500 55.5000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 2.9900 2.9900
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 12 11.500000 540.5900 47.0078
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 47 45.250000 2262.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 38 38.500000 1925.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 1.000000 50.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 38 50.000000 2500.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 32 44.250000 2212.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 26 25.250000 1262.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 55 63.000000 3150.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 29 30.750000 1537.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 110 371.750000 18587.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 74 228.250000 11412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 93 293.000000 2930.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 18.000000 1285.9200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.750000 125.0200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 5 21.000000 1341.8900 63.8995
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 26.500000 1893.1600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 3.500000 250.0400 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.250000 9.2500 37.0000
TRAV-TRAVS-Travel by mile 345 20634.00000 9179.5700 0.4449
Subtotal (Total Children Is Unduplicated) 489 21900.50000 62127.3500 2.8368
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Total 21912.000000 62667.9400 2.8600
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Number of Children (Unduplicated) With at Least One Service 489
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Center 03
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 1970 16525.750000 51198.2300 51198.2300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 123 1171.250000 2206.1300 2206.1300
T 0 0.000000 0.0000 0.0000
446 4215.000000 9263.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2539 21912.000000 62667.9400 53404.3600