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
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 2 2.000000 97.0000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 19 37.250000 1862.5000 50.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 12 20.000000 1110.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 43 80.250000 4538.1000 56.5495
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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 23 64.000000 3200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 10.000000 500.0000 50.0000
INTR-T1013-INTERPRETER 70 184.500000 9186.5000 49.7913
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1240 7002.000000 70020.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 33.000000 2357.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 31.000000 2214.6400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 357.2000 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) 1351 32551.00000 124050.5800 3.8110
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Total 32631.250000 128588.6800 3.9407
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Number of Children (Unduplicated) With at Least One Service 1365
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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 5450 15602.500000 73040.0600 73040.0600
D 924 4980.250000 10751.3700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3331 12041.500000 44321.0000 44321.0000
5 7.000000 476.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9710 32631.250000 128588.6800 117361.0600