CMS/EIP Fiscal Report Center: 52
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
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 53.500000 4012.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 34.000000 2550.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 27 54.000000 2997.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 5 10.000000 555.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 99 222.000000 14529.3000 65.4473
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 17.750000 887.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 48 50.250000 2487.5000 49.5025
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 19 15.250000 381.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 34 46.500000 2325.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 59.000000 2950.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 7 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 21 49.750000 2487.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 14.500000 725.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 251 994.750000 49365.1000 49.6256
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 23 28.250000 1412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 455 2337.000000 23370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 38.750000 2768.3000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 10 16.500000 1178.7600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 10 33.000000 1887.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 24 113.000000 8072.7200 71.4400
OCCT-97530TLHM-OT SESSION BY OT ASST 10 26.500000 1515.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 22 74.750000 5340.1400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 8.000000 571.5200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 6 34.000000 1943.4400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 5.000000 285.8000 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 25 80.250000 5733.0600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 11.000000 785.8400 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 3 21.250000 1214.6500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 85 418.750000 28915.3400 69.0516
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 17.000000 1214.4800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 71 312.250000 22221.3800 71.1653
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 9 19.500000 1393.0800 71.4400
TRAV-TRAVS-Travel by mile 302 16732.00000 7444.4200 0.4449
Subtotal (Total Children Is Unduplicated) 482 21594.50000 179734.8800 8.3232
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Total 21816.500000 194264.1800 8.9045
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Number of Children (Unduplicated) With at Least One Service 521
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Center 52
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 0 0.000000 0.0000 0.0000
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 2447 19685.750000 75012.9000 74812.9000
1054 2130.750000 119251.2800 533.6300
Other 0 0.000000 0.0000 0.0000
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Total 3501 21816.500000 194264.1800 75346.5300