CMS/EIP Fiscal Report Center: 06
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 8 16.000000 800.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.500000 223.5000 63.8571
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 111.7500 31.9286
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 57 103.000000 7543.8100 73.2409
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 23 41.500000 3075.0000 74.0964
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 71 129.000000 7113.7500 55.1453
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 89 309.500000 19696.5600 63.6399
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 51.000000 2425.0000 47.5490
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 16 15.500000 775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 58 46.000000 1150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 6 7.250000 337.5000 46.5517
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.500000 275.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 17 15.750000 381.2500 24.2063
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.750000 337.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 3 5.500000 275.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 2.750000 68.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.500000 25.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 13.500000 325.0000 24.0741
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1020 7201.250000 359962.5000 49.9861
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 205 704.000000 35100.0000 49.8580
INTR-T1013-INTERPRETER 8 70.000000 5600.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1145 8564.000000 85460.0000 9.9790
OCCT-97530-OT SESSION BY LICENSED OT 29 133.250000 9342.5100 70.1126
OCCT-97530GT-OT SESSION BY LICENSED OT 12 24.000000 1613.8900 67.2454
OCCT-97530HM-OT SESSION BY OT ASST 20 99.000000 4570.1800 46.1634
OCCT-97530HMGT-OT SESSION BY OT ASST 5 15.000000 858.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 44 174.750000 12319.2100 70.4962
PHY-97110GT-PT SESSION BY LICENSED PT 13 34.000000 2428.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 18 58.500000 3343.8600 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 4 6.000000 342.9600 57.1600
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 119 492.250000 33946.4900 68.9619
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 53 193.750000 13781.5000 71.1303
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1299 17946.75000 575331.5600 32.0577
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Total 18256.250000 595028.1200 32.5931
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Number of Children (Unduplicated) With at Least One Service 1317
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Center 06
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 8197 7950.000000 166805.1700 166805.1700
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 0 0.000000 0.0000 0.0000
10816 10306.250000 428222.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19013 18256.250000 595028.1200 166805.1700