CMS/EIP Fiscal Report Center: 55
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 14.000000 1050.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 19.615466 1471.1600 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 7 14.000000 777.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 205.6400 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 0.858588 44.1400 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 308.4600 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 0.805485 41.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 2.309473 118.7300 51.4100
Subtotal (Total Children Is Unduplicated) 47 90.589012 5900.9500 65.1398
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 368.2600 368.2600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 9 9.000000 450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 25 27.500000 1375.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 9 9.000000 450.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 23 31.000000 775.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 32.500000 1625.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 27 74.000000 1850.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 23.000000 1150.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 9 9.000000 450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 18 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 477.500000 23875.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 22.000000 1100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 548 4462.000000 44620.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 118.668844 8539.4100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 26 160.340279 9235.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 23 128.388272 9238.8200 71.9600
PHY-97110HM-PT SESSION BY PT ASST 18 73.921995 4254.9500 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 38 175.291551 12613.9800 71.9600
TRAV-TRAVS-Travel by mile 50 1866.000000 830.0600 0.4448
Subtotal (Total Children Is Unduplicated) 570 7725.110941 123545.0000 15.9927
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Total 7815.699953 129445.9500 16.5623
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Number of Children (Unduplicated) With at Least One Service 587
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Center 55
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 5163 6258.705680 111314.5100 111314.5100
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
984 1556.994273 18131.4400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6147 7815.699953 129445.9500 111314.5100