CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 3 3.000000 65.5200 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 45.8000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 2 3.500000 175.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 19.000000 1054.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 24 46.500000 2580.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 81.500000 6075.0000 74.5399
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 86 162.000000 10330.9600 63.7714
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 465.4500 465.4500
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 19.500000 975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 211 272.500000 13625.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 5.500000 137.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 284 1407.500000 70375.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 454 2185.000000 21850.0000 10.0000
TRAV-TRAVS-Travel by mile 352 23859.00000 10620.4000 0.4451
Subtotal (Total Children Is Unduplicated) 456 27753.00000 118123.3500 4.2562
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Total 27915.000000 128454.3100 4.6016
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Number of Children (Unduplicated) With at Least One Service 457
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Center 53
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 1908 10236.950000 23928.3900 23928.3900
T 2115 13196.750000 23740.4900 23740.4900
1801 4481.300000 80785.4300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5824 27915.000000 128454.3100 47668.8800