CMS/EIP Fiscal Report Center: 51
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
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-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 4.500000 249.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 17 24.000000 1725.0000 71.8750
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 70 74.500000 4134.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 34.500000 2587.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 561.5500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 203.1500 50.7875
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 128 187.500000 11601.2000 61.8731
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 8.000000 2516.0400 314.5050
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 172 1250.000000 61820.0000 49.4560
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 16.000000 800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 460 3881.000000 38810.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 105 348.250000 23665.6800 67.9560
OCCT-97530GT-OT SESSION BY LICENSED OT 3 9.250000 646.5800 69.9005
OCCT-97530HM-OT SESSION BY OT ASST 58 218.000000 12407.1200 56.9134
OCCT-97530HMGT-OT SESSION BY OT ASST 4 10.000000 572.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 47 351.750000 25106.8600 71.3770
PHY-97110GT-PT SESSION BY LICENSED PT 4 27.000000 1928.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 19 61.750000 3259.3400 52.7828
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 42.9000 42.9000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 204 1310.500000 92489.7500 70.5759
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1500.2400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 7.000000 500.0800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 8.000000 571.5200 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 4 3195.000000 1421.6700 0.4450
Subtotal (Total Children Is Unduplicated) 498 10730.50000 268372.5400 25.0103
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Total 10918.000000 279973.7400 25.6433
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Number of Children (Unduplicated) With at Least One Service 543
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Center 51
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 23 30.000000 2045.2500 0.0000
P 1862 8783.750000 152308.6800 152308.6800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 22.000000 1228.7600 1228.7600
T 0 0.000000 0.0000 0.0000
793 2082.250000 124391.0500 308.0000
Other 0 0.000000 0.0000 0.0000
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Total 2684 10918.000000 279973.7400 153845.4400