CMS/EIP Fiscal Report Center: 54
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 23.500000 1304.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 22 42.500000 2624.7500 61.7588
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 22.000000 1040.0500 47.2750
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 30 24.250000 1212.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 48 37.750000 1887.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 16.000000 800.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 13 23.500000 1175.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 6.250000 312.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 27.500000 1375.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 51 284.500000 14225.0000 50.0000
INTR-T1013-INTERPRETER 8 42.750000 1693.7500 39.6199
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 54 155.000000 1550.0000 10.0000
PHY-97110GT-PT SESSION BY LICENSED PT 2 8.000000 571.5200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 28 41.000000 1517.0000 37.0000
TRAV-TRAVS-Travel by mile 52 3967.000000 1765.1200 0.4450
Subtotal (Total Children Is Unduplicated) 215 4656.500000 29174.9400 6.2654
-----------------------------------------------------------------------------------------------------------------------
Total 4699.000000 31799.6900 6.7673
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 227
-----------------------------------------------------------------------------------------------------------------------
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 454 2037.250000 16864.9500 16864.9500
432 2661.750000 14934.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 886 4699.000000 31799.6900 16864.9500