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
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 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 36 70.500000 5287.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 85.500000 6412.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 23.500000 1762.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 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) 112 266.000000 18676.1000 70.2109
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 66.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 63 109.000000 5437.5000 49.8853
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 21 33.000000 1650.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 84 110.250000 2756.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 13.000000 650.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 12.000000 600.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 27.000000 1350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 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 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 195 1134.000000 56700.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 66 334.000000 16700.0000 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 61 324.500000 23182.2800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 9.000000 642.9600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 40 224.000000 16002.5600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 5 16.000000 1143.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 173 1158.500000 82763.2400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 115.000000 8215.6000 71.4400
TRAV-TRAVS-Travel by mile 531 50186.00000 22070.2700 0.4398
Subtotal (Total Children Is Unduplicated) 811 54047.25000 244147.7000 4.5173
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Total 54313.250000 262823.8000 4.8390
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Number of Children (Unduplicated) With at Least One Service 875
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Center 09
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 1801 37482.750000 188471.1600 188471.1600
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 736 16812.500000 73052.6400 73052.6400
1 2.000000 100.0000 0.0000
Other 8 16.000000 1200.0000 0.0000
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Total 2546 54313.250000 262823.8000 261523.8000