CMS/EIP Fiscal Report Center: 57
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
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 15.000000 765.7500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 45 57.000000 2909.8500 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 4.750000 237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 51 52.000000 2600.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 89 91.000000 4550.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 22 28.250000 1412.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 47 47.000000 2350.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 150 151.000000 7550.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 216.000000 5400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 778 5457.000000 272850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 231 1107.750000 55387.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 779 5743.000000 57430.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 15.500000 1107.3200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 8 37.000000 2116.4000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 3 13.000000 743.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 10 43.000000 3071.9200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 3 9.500000 678.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 15 92.500000 5287.3000 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 16.500000 943.1400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 129.500000 9251.4800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 84.500000 6036.6800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 28.500000 1630.2000 57.2000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 6 28.750000 1063.7500 37.0000
TRAV-TRAVS-Travel by mile 9 2348.000000 1044.8400 0.4450
Subtotal (Total Children Is Unduplicated) 966 15748.50000 442948.1900 28.1264
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Total 15805.500000 445858.0400 28.2090
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Number of Children (Unduplicated) With at Least One Service 976
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Center 57
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 4 5.000000 90.0000 90.0000
H 0 0.000000 0.0000 0.0000
T 2910 10819.000000 198305.6100 198295.6100
1420 4960.000000 246648.7700 246648.7700
Other 12 21.500000 813.6600 813.6600
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Total 4346 15805.500000 445858.0400 445848.0400