CMS/EIP Fiscal Report Center: 02
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
EXIT-EXIT-EXIT ASSESSMENT 6 6.000000 300.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
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 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 16 27.000000 1539.4100 57.0152
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 49.9900 49.9900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 15.500000 775.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 6 5.750000 287.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 50 49.250000 2462.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 12 9.000000 450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.750000 18.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 17 16.500000 825.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 10.750000 537.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.500000 75.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 6 4.500000 225.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 13 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 339.000000 16950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 78.000000 3900.0000 50.0000
INTR-T1013-INTERPRETER 20 88.250000 4412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 284 1691.000000 16910.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 9.000000 647.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 3 5.250000 188.5900 35.9219
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 11.000000 791.5600 71.9600
TRAV-TRAVS-Travel by mile 124 8844.000000 3934.5600 0.4449
Subtotal (Total Children Is Unduplicated) 342 11198.00000 54450.8900 4.8626
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Total 11225.000000 55990.3000 4.9880
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Number of Children (Unduplicated) With at Least One Service 343
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Center 02
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 2389 9999.250000 50570.8300 50565.8300
345 1225.750000 5419.4700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2734 11225.000000 55990.3000 50565.8300