CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 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 19 28.000000 2100.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 88 179.000000 12975.0000 72.4860
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1350.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 41 82.000000 4551.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 18 18.000000 900.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 530.8900 48.2627
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 179 392.000000 26001.9900 66.3316
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 31.500000 1575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 61 62.250000 3112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 9.500000 237.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 44 74.250000 3712.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 19 25.500000 1275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 72.250000 3612.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 24 20.750000 1037.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 13.250000 662.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 4 1.750000 87.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 34 38.250000 1912.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 15 14.000000 700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 153 875.750000 43687.5000 49.8858
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 54 156.500000 7825.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 410 2820.000000 28200.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 110.500000 7483.3400 67.7225
OCCT-97530GT-OT SESSION BY LICENSED OT 10 20.750000 1339.5000 64.5542
OCCT-97530HM-OT SESSION BY OT ASST 10 29.500000 1401.4000 47.5051
OCCT-97530HMGT-OT SESSION BY OT ASST 2 3.500000 200.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 36 194.750000 13912.9400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 14 27.500000 1964.6000 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 3 4.500000 257.4000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 7 14.500000 829.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 35 203.250000 12984.2200 63.8830
PHY-97110GT-PT SESSION BY LICENSED PT 2 7.500000 321.4800 42.8640
PHY-97110TL-PT SESSION BY LICENSED PT 31 173.000000 12359.1200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 104 726.500000 48043.1300 66.1296
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 34.250000 2339.6600 68.3112
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 66 308.750000 22057.1000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 11.250000 803.7000 71.4400
TRAV-TRAVS-Travel by mile 308 25950.00000 11546.2500 0.4449
Subtotal (Total Children Is Unduplicated) 488 32040.50000 235605.9400 7.3534
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Total 32432.500000 261607.9300 8.0662
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Number of Children (Unduplicated) With at Least One Service 547
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Center 52
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 3033 30102.750000 120326.3400 120326.3400
1106 2329.750000 141281.5900 75.3000
Other 0 0.000000 0.0000 0.0000
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Total 4139 32432.500000 261607.9300 120401.6400