CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.000000 884.9300 68.0715
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 21 32.500000 2093.8400 64.4258
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 58.500000 2925.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 62 77.500000 3862.5000 49.8387
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 16 16.750000 418.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 30 34.000000 1700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 66 88.500000 4425.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 27.000000 1350.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 22 31.000000 1550.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 19.000000 950.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 13 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 26 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 52 76.250000 3812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 176.250000 8812.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 6.000000 300.0000 50.0000
INTR-T1013-INTERPRETER 87 245.250000 12262.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1298 5887.000000 58780.0000 9.9847
OCCT-97530-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 6 24.000000 1418.9600 59.1233
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 18.000000 1295.2800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 542 31198.00000 12909.3700 0.4138
Subtotal (Total Children Is Unduplicated) 1431 38046.50000 119869.6600 3.1506
-----------------------------------------------------------------------------------------------------------------------
Total 38079.000000 121963.5000 3.2029
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1443
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4566 23264.750000 59833.9000 59833.9000
D 512 3066.500000 6430.2400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4249 11715.750000 55228.2400 55208.2400
6 32.000000 471.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9333 38079.000000 121963.5000 115042.1400