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
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
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 5.000000 375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 4.000000 300.0000 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 10 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 10.000000 750.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 101.0500 50.5250
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 37 42.000000 2671.0000 63.5952
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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
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 253.000000 12170.0000 48.1028
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 460 3881.000000 38810.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 133.000000 8715.6600 65.5313
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 128.6400 64.3200
OCCT-97530HM-OT SESSION BY OT ASST 19 74.000000 4226.6500 57.1169
OCCT-97530HMGT-OT SESSION BY OT ASST 1 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 20 134.500000 9586.5200 71.2752
PHY-97110GT-PT SESSION BY LICENSED PT 4 24.000000 1714.5600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 6 24.750000 1201.2000 48.5333
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 42.9000 42.9000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 61 366.250000 25787.3100 70.4090
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 21.000000 1500.2400 71.4400
TRAV-TRAVS-Travel by mile 4 3195.000000 1421.6700 0.4450
Subtotal (Total Children Is Unduplicated) 468 8129.500000 108450.1900 13.3403
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Total 8171.500000 111121.1900 13.5986
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Number of Children (Unduplicated) With at Least One Service 478
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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 0 0.000000 0.0000 0.0000
P 1635 8146.000000 110265.4900 110265.4900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 10.000000 407.2000 407.2000
T 0 0.000000 0.0000 0.0000
7 15.500000 448.5000 308.0000
Other 0 0.000000 0.0000 0.0000
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Total 1644 8171.500000 111121.1900 110980.6900