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
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
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 1 2.000000 111.0000 55.5000
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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 45.500000 2275.0000 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 56.000000 2800.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 3.000000 150.0000 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 5 24.000000 1077.6000 44.9000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 455 2329.000000 23290.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 0.500000 35.7200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 6.000000 342.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 428.6400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 4.000000 285.7600 71.4400
TRAV-TRAVS-Travel by mile 302 16580.00000 7376.7900 0.4449
Subtotal (Total Children Is Unduplicated) 476 19216.50000 45674.1000 2.3768
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Total 19218.500000 45785.1000 2.3823
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Number of Children (Unduplicated) With at Least One Service 476
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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 2179 19043.500000 45707.2300 45707.2300
2 175.000000 77.8700 77.8700
Other 0 0.000000 0.0000 0.0000
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Total 2181 19218.500000 45785.1000 45785.1000