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
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
EXIT-EXIT-EXIT ASSESSMENT 5 10.000000 500.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 35 71.000000 5325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 45 88.500000 6637.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 12 24.000000 1800.0000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 4.000000 200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 229.7300 45.9460
Subtotal (Total Children Is Unduplicated) 102 255.500000 18292.2800 71.5941
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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 73 103.250000 5162.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 33.000000 1650.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 73 86.750000 2168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 6.000000 300.0000 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 7 7.000000 350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 14.000000 700.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 7.000000 350.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 294 1568.500000 78425.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 6 16.000000 800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 33 190.000000 1900.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 78 388.250000 27736.5800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 1 7.000000 500.0800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 68 346.500000 24753.9600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 8 41.000000 2929.0400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 206 1165.750000 82781.1000 71.0110
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 16.000000 1143.0400 71.4400
TRAV-TRAVS-Travel by mile 910 81731.00000 35860.7100 0.4388
Subtotal (Total Children Is Unduplicated) 1081 85774.00000 269860.2600 3.1462
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Total 86029.500000 288152.5400 3.3495
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Number of Children (Unduplicated) With at Least One Service 1134
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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 2548 58630.750000 213605.5000 213605.5000
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
909 27354.250000 71235.0400 0.0000
Other 24 44.500000 3312.0000 0.0000
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Total 3481 86029.500000 288152.5400 213605.5000