CMS/EIP Fiscal Report Center: 09
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
EXIT-EXIT-EXIT ASSESSMENT 5 10.000000 500.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 132 265.000000 19875.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 56 112.000000 8400.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 92 178.500000 13387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 54 104.500000 5799.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 52 102.000000 7650.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 4.000000 200.0000 50.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 255.2500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 18.000000 893.3800 49.6322
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 5 5.000000 222.7500 44.5500
Subtotal (Total Children Is Unduplicated) 318 875.000000 62124.7800 70.9997
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 199.5000 66.5000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 90 128.250000 6412.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 40 67.500000 3375.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 92 115.250000 2881.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 15.000000 750.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 7 11.000000 550.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 23.000000 1150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 15 15.000000 750.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 16.000000 800.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 10 15.000000 750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 966 7035.500000 351775.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 82.000000 4100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 33 190.000000 1900.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 165 975.250000 69478.9400 71.2422
OCCT-97530GT-OT SESSION BY LICENSED OT 4 13.000000 928.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 173 1226.000000 87125.0900 71.0645
PHY-97110GT-PT SESSION BY LICENSED PT 33 212.000000 15145.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 424 3143.750000 223855.7700 71.2066
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 33 161.000000 11333.3600 70.3935
TRAV-TRAVS-Travel by mile 1096 115089.0000 50518.9000 0.4390
Subtotal (Total Children Is Unduplicated) 1391 128554.5000 834579.3100 6.4920
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Total 129429.500000 896704.0900 6.9281
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Number of Children (Unduplicated) With at Least One Service 1570
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Center 09
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 3925 83789.250000 355236.3200 355236.3200
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 0 0.000000 0.0000 0.0000
3444 45225.750000 511770.7700 0.0000
Other 212 414.500000 29697.0000 0.0000
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Total 7581 129429.500000 896704.0900 355236.3200