CMS/EIP Fiscal Report Center: 53
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 43.6800 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 45.8000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 54.500000 3024.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 64.000000 4800.0000 75.0000
Subtotal (Total Children Is Unduplicated) 73 142.500000 9063.8200 63.6058
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 4759.7200 1586.5733
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 7.750000 387.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 205 252.500000 12625.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 6 2.000000 50.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 328 2067.750000 103387.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 451 2865.000000 28650.0000 10.0000
TRAV-TRAVS-Travel by mile 355 36893.00000 16407.3100 0.4447
Subtotal (Total Children Is Unduplicated) 456 42093.00000 166317.0300 3.9512
-----------------------------------------------------------------------------------------------------------------------
Total 42235.500000 175380.8500 4.1525
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 457
-----------------------------------------------------------------------------------------------------------------------
Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1543 9338.500000 18887.0900 18887.0900
T 1923 12919.250000 22687.9400 22687.9400
4181 19977.750000 133805.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7647 42235.500000 175380.8500 41575.0300