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
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
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 72.9400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.000000 70.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 7.000000 56.4200 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 11.000000 240.2400 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 183.2000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 7 9.000000 450.0000 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 17 23.500000 1304.2500 55.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 45.126667 3497.0000 77.4930
Subtotal (Total Children Is Unduplicated) 68 143.126667 7448.3000 52.0399
-----------------------------------------------------------------------------------------------------------------------
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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 103 779.283600 38639.1800 49.5830
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 913 12780.00000 127087.5000 9.9442
TRAV-A0160-*PROV TRAVEL TO NATURAL ENV-BY MIN 307 33136.00000 16584.5000 0.5005
TRAV-TRAVS-Travel by mile 764 152689.0000 67951.5870 0.4450
Subtotal (Total Children Is Unduplicated) 969 200693.5336 328172.1970 1.6352
-----------------------------------------------------------------------------------------------------------------------
Total 200836.660267 335620.4970 1.6711
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 970
-----------------------------------------------------------------------------------------------------------------------
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 17465 124433.160267 217297.5620 217290.8920
T 9090 73157.500000 116645.4350 116608.8700
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26555 197590.660267 333942.9970 333899.7620