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:OTHER
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
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 4 6.000000 402.1000 67.0167
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 19 25.000000 1250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 34.500000 1725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 4.000000 200.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 5.000000 250.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 7 12.000000 600.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 146 926.000000 46300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 11.000000 550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 169.000000 12073.3600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 58 359.000000 25361.2000 70.6440
PHY-97110GT-PT SESSION BY LICENSED PT 15 63.000000 4500.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 124 740.000000 52865.6000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 79.000000 5643.7600 71.4400
TRAV-TRAVS-Travel by mile 462 33358.00000 14658.1900 0.4394
Subtotal (Total Children Is Unduplicated) 583 35828.00000 167340.3300 4.6707
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Total 35834.000000 167742.4300 4.6811
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Number of Children (Unduplicated) With at Least One Service 585
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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 1205 24696.000000 109390.4600 109390.4600
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
524 11138.000000 58351.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1729 35834.000000 167742.4300 109390.4600