CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 17.5000 8.7500
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 24 44.750000 2237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 29.000000 2175.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.000000 1221.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 663.6500 51.0500
Subtotal (Total Children Is Unduplicated) 62 122.250000 6894.7800 56.3990
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 59.500000 2975.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 108 433.750000 21687.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.250000 106.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 292 2065.750000 102710.3000 49.7206
INTR-T1013-INTERPRETER 6 57.000000 2920.0000 51.2281
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1065 8205.000000 82148.9400 10.0121
OCCT-97530-OT SESSION BY LICENSED OT 9 70.000000 4929.1200 70.4160
PHY-97110-PT SESSION BY LICENSED PT 9 60.000000 4272.1200 71.2020
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 50 290.750000 18849.2400 64.8297
TRAV-TRAVS-Travel by mile 24 799.000000 355.6100 0.4451
Subtotal (Total Children Is Unduplicated) 1071 12047.00000 241054.0800 20.0095
-----------------------------------------------------------------------------------------------------------------------
Total 12169.250000 247948.8600 20.3750
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1071
-----------------------------------------------------------------------------------------------------------------------
Center 07
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 4443 12169.250000 247948.8600 247878.8600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4443 12169.250000 247948.8600 247878.8600