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
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-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 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 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 13 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 54 88.500000 6637.5000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 27 38.000000 2850.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 93 164.500000 12244.0500 74.4319
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 106 152.000000 7600.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 20 19.750000 493.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 22 32.750000 1637.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 20.000000 1000.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 24 27.000000 1350.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 30 49.000000 2450.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 5.500000 137.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 287 1713.750000 85687.5000 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 53 285.000000 18327.8700 64.3083
PHY-97110-PT SESSION BY LICENSED PT 86 496.000000 34589.3100 69.7365
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 231 1511.500000 101092.7600 66.8824
TRAV-TRAVS-Travel by mile 1165 96316.00000 42613.7000 0.4424
Subtotal (Total Children Is Unduplicated) 1222 101185.2500 306311.8900 3.0272
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Total 101349.750000 318555.9400 3.1431
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Number of Children (Unduplicated) With at Least One Service 1270
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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 4363 97300.250000 304454.6400 304454.6400
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
190 4049.500000 14101.3000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4553 101349.750000 318555.9400 304454.6400