CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.000000 55.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 78.000000 5850.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 145 234.500000 17587.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 112.500000 8412.5000 74.7778
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 34 168.000000 8400.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 293 633.500000 42997.8000 67.8734
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 137 199.250000 9962.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 28 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 38 71.250000 3562.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 24.000000 1200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 46.250000 2312.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 9.000000 225.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 49 84.000000 4200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 980 7161.750000 358087.5000 50.0000
INTR-T1013-INTERPRETER 4 86.000000 4080.0000 47.4419
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 73 461.000000 4610.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 115 918.000000 63479.8100 69.1501
PHY-97110-PT SESSION BY LICENSED PT 187 1445.000000 102103.8200 70.6601
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 363 3253.000000 225333.9200 69.2696
TRAV-TRAVS-Travel by mile 1345 139624.0000 61789.6100 0.4425
Subtotal (Total Children Is Unduplicated) 1409 153425.5000 842414.1600 5.4907
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Total 154059.000000 885411.9600 5.7472
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Number of Children (Unduplicated) With at Least One Service 1503
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Center 09
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 6290 142561.000000 442401.4800 442401.4800
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
2477 11259.500000 425294.2300 0.0000
Other 158 238.500000 17716.2500 0.0000
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Total 8925 154059.000000 885411.9600 442401.4800