CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 19 37.250000 1862.5000 50.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 34 59.500000 4462.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 98 160.500000 8907.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 63.000000 4725.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 208 392.750000 24477.9000 62.3244
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 55 61.000000 3050.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 75 90.750000 4537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 18.750000 468.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 46 62.750000 3137.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 59 91.500000 4525.0000 49.4536
CONIP-CONIP-CONSULT, ITDS PHONE 6 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 20.000000 1000.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 15 20.000000 1000.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 12 18.000000 900.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 10 63.000000 700.0000 11.1111
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 31 39.000000 1950.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 40 64.750000 3237.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 384 2017.000000 100850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 62 143.500000 7175.0000 50.0000
INTR-T1013-INTERPRETER 70 184.500000 9186.5000 49.7913
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1240 7003.000000 70030.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 15 57.500000 4059.6800 70.6031
OCCT-97530GT-OT SESSION BY LICENSED OT 7 17.750000 1268.0600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 33 159.500000 11394.6800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 5 5.000000 291.9800 58.3960
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 319.500000 22623.9000 70.8103
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 25 79.250000 5661.6200 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 7 8.500000 314.5000 37.0000
TRAV-TRAVS-Travel by mile 381 24649.00000 10938.5900 0.4438
Subtotal (Total Children Is Unduplicated) 1374 35206.00000 268613.2600 7.6298
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Total 35598.750000 293091.1600 8.2332
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Number of Children (Unduplicated) With at Least One Service 1462
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Center 01
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 7010 17169.250000 159092.3900 159092.3900
D 1259 5342.250000 30988.9300 0.0000
S 2 3.000000 195.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 4207 12930.250000 92904.8400 92389.0700
7 9.000000 613.7500 0.0000
Other 87 145.000000 9295.5000 0.0000
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Total 12572 35598.750000 293091.1600 251481.4600