CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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 27 42.250000 2112.5000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 21.1400 21.1400
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 57 102.250000 6038.0900 59.0522
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 629.4600 314.7300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 11.750000 587.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 23 27.500000 1375.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 60 95.250000 4762.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 94 240.500000 12025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 49 77.250000 3862.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 3 4.750000 237.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 28 53.500000 2675.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 62 96.250000 4812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 71 520.000000 26000.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 67.000000 3350.0000 50.0000
INTR-T1013-INTERPRETER 16 79.000000 3950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 309 1998.000000 19980.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 100.000000 6130.6100 61.3061
OCCT-97530GT-OT SESSION BY LICENSED OT 2 13.500000 402.0400 29.7807
PHY-97110-PT SESSION BY LICENSED PT 15 60.500000 2646.0900 43.7370
PHY-97110GT-PT SESSION BY LICENSED PT 4 16.500000 995.7800 60.3503
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 46 251.500000 16907.6300 67.2272
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 9 34.250000 2446.8200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 1.500000 55.5000 37.0000
TRAV-TRAVS-Travel by mile 132 11792.00000 5246.2900 0.4449
Subtotal (Total Children Is Unduplicated) 389 15549.50000 119277.7200 7.6708
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Total 15651.750000 125315.8100 8.0065
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Number of Children (Unduplicated) With at Least One Service 401
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Center 02
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 16 15.500000 345.7200 345.7200
H 0 0.000000 0.0000 0.0000
T 4334 13312.750000 121858.2400 121731.2400
148 2323.500000 3111.8500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4498 15651.750000 125315.8100 122076.9600