CMS/EIP Fiscal Report Center: 09
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
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.500000 973.5000 72.1111
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 78 154.500000 11587.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 33 66.000000 4950.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 93 182.500000 13687.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 51 101.000000 5605.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 77.000000 5775.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 269 662.500000 46534.4000 70.2406
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 66.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 70 117.000000 5837.5000 49.8932
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 27 45.500000 2275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 103 136.250000 3406.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 13 14.000000 700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 14.000000 700.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 29.000000 1450.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 10.000000 500.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 21.500000 1075.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 5 6.000000 300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 791 5857.000000 292850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 210 1081.000000 54050.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 33 188.000000 1880.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 140 899.000000 63377.5700 70.4979
OCCT-97530GT-OT SESSION BY LICENSED OT 18 91.000000 6501.0400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 163 1192.000000 84142.9300 70.5897
PHY-97110GT-PT SESSION BY LICENSED PT 29 111.750000 7983.4200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 377 3101.750000 220179.2500 70.9855
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 83 476.000000 33759.2500 70.9228
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 744 81128.00000 35627.4200 0.4392
Subtotal (Total Children Is Unduplicated) 1302 94547.25000 817554.1500 8.6470
-----------------------------------------------------------------------------------------------------------------------
Total 95209.750000 864088.5500 9.0756
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1423
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 2884 58067.250000 327543.8700 327543.8700
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 1393 30414.000000 148393.2500 148393.2500
1928 6418.500000 366597.9300 0.0000
Other 157 310.000000 21553.5000 0.0000
---------------------------------------------------------
Total 6362 95209.750000 864088.5500 475937.1200