CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 12.6100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.2600 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 25.3100 25.3100
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 23 28.000000 1400.0000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 42.000000 3045.0000 72.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 18.000000 999.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 25.500000 1912.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 26.0500 26.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 62 132.500000 8256.3300 62.3119
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 13.000000 15332.3400 1179.4108
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 29.750000 1487.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 34 28.250000 1412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 12.250000 612.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 2.000000 50.0000 25.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 29 18.000000 900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 53 310.500000 15525.0000 50.0000
INTR-T1013-INTERPRETER 17 59.500000 2975.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 408 2890.000000 28900.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 212.750000 14027.3600 65.9335
PHY-97110-PT SESSION BY LICENSED PT 38 166.000000 10152.6200 61.1604
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 676.000000 48293.4400 71.4400
TRAV-TRAVS-Travel by mile 131 4439.000000 1975.9500 0.4451
Subtotal (Total Children Is Unduplicated) 509 8860.250000 141725.4600 15.9957
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Total 8992.750000 149981.7900 16.6781
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Number of Children (Unduplicated) With at Least One Service 515
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Center 02
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 0 0.000000 0.0000 0.0000
T 4613 8616.750000 142349.5400 141022.2540
397 376.000000 7632.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5010 8992.750000 149981.7900 141022.2540