CMS/EIP Fiscal Report Center: 07
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
EXIT-EXIT-EXIT ASSESSMENT 51 80.500000 4025.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 265.0000 44.1667
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 65 110.500000 5652.1000 51.1502
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 33.500000 1675.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 38 37.750000 1887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 19.500000 487.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 112 149.500000 7475.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 104 200.000000 10000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 49 56.250000 2812.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 41 51.250000 2562.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 42.750000 2137.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 20 30.750000 1537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 48 56.500000 2825.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 67 101.000000 5050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 216 1025.750000 51287.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 69 289.500000 14475.0000 50.0000
INTR-T1013-INTERPRETER 2 7.000000 370.0000 52.8571
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 895 5813.000000 58240.0000 10.0189
OCCT-97530-OT SESSION BY LICENSED OT 9 29.000000 1519.7200 52.4041
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.000000 247.6500 61.9125
PHY-97110-PT SESSION BY LICENSED PT 2 4.000000 107.2600 26.8150
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 125.000000 5915.1900 47.3215
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.000000 243.5600 34.7943
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.750000 39.1700 52.2267
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 14 21.500000 795.5000 37.0000
TRAV-TRAVS-Travel by mile 22 2630.000000 1170.1200 0.4449
Subtotal (Total Children Is Unduplicated) 966 10739.75000 172973.1700 16.1059
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Total 10850.250000 178625.2700 16.4628
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Number of Children (Unduplicated) With at Least One Service 974
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Center 07
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 3326 10849.500000 178606.5200 178606.5200
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 0 0.000000 0.0000 0.0000
1 0.750000 18.7500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3327 10850.250000 178625.2700 178606.5200