CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 3 3.000000 153.1500 51.0500
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 93 96.750000 4837.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 77 72.750000 3637.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 37 47.500000 2375.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 11 15.250000 762.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 19 21.750000 1087.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 9 10.000000 500.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 101 137.000000 6850.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 22 34.000000 1700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 147 613.000000 30650.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 76 305.250000 15262.5000 50.0000
INTR-T1013-INTERPRETER 6 69.000000 3250.0000 47.1014
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 154 576.000000 5560.0000 9.6528
OCCT-97530-OT SESSION BY LICENSED OT 5 14.000000 1000.1600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 8 24.750000 1718.6700 69.4412
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 36.250000 2589.7000 71.4400
TRAV-TRAVS-Travel by mile 448 31417.00000 13976.9300 0.4449
Subtotal (Total Children Is Unduplicated) 606 33491.25000 95782.9600 2.8599
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Total 33494.250000 95936.1100 2.8643
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Number of Children (Unduplicated) With at Least One Service 606
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Center 03
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 1664 14583.500000 42010.4600 42010.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 52 441.250000 1695.3500 1695.3500
T 0 0.000000 0.0000 0.0000
2160 18469.500000 52230.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3876 33494.250000 95936.1100 43705.8100