CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 ending 06/30/2016 Date of Report:08/06/2016 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 83.3600 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 10.000000 87.5000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 7 9.000000 72.5400 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 14.000000 305.7600 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.000000 206.1000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 7 9.000000 450.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.000000 975.0000 81.2500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 90.500000 5022.7500 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 130 238.500000 13597.5000 57.0126
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 170 282.500000 22200.0000 78.5841
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 338 716.000000 45428.9900 63.4483
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 10.000000 10999.4300 1099.9430
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 83 54.500000 2762.5000 50.6881
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 3.000000 75.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 558 1221.500000 63535.0000 52.0139
CONIP-CONIP-CONSULT, ITDS PHONE 51 20.000000 525.0000 26.2500
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 652 9683.000000 483712.5000 49.9548
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 913 12782.00000 127107.5000 9.9443
TRAV-A0160-*PROV TRAVEL TO NATURAL ENV-BY MIN 307 33136.00000 16584.5000 0.5005
TRAV-TRAVS-Travel by mile 764 152749.0000 67978.2970 0.4450
Subtotal (Total Children Is Unduplicated) 970 209661.2500 773342.2270 3.6885
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Total 210377.250000 818771.2170 3.8919
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Number of Children (Unduplicated) With at Least One Service 973
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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 17465 124433.160267 217297.5620 217290.8920
T 9090 73157.500000 116645.4350 116608.8700
9251 9515.589733 481900.7200 550.0000
Other 0 0.000000 0.0000 0.0000
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Total 35806 207106.250000 815843.7170 334449.7620