CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 06/30/2017 Date of Report:08/05/2017 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 10.000000 117.3400 11.7340
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 18 19.000000 161.3500 8.4921
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 11 11.000000 94.6600 8.6055
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 20 21.000000 496.8100 23.6576
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 11 11.000000 225.4900 20.4991
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 25.5300 25.5300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
EXIT-EXIT-EXIT ASSESSMENT 4 5.000000 250.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 30 85.500000 6412.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 33.500000 2512.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 92 217.000000 11952.5000 55.0806
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 16 27.500000 2062.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 26.500000 1987.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 109 199.500000 11072.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 175 301.000952 22575.0221 74.9998
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
WHEELO-97003TG-WHEELCHAIR EVAL/ FITTING BY LICENSED O 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 387 979.000952 60507.7821 61.8056
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 8.000000 4171.1300 521.3913
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 60 47.000000 2350.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 587 903.750000 45162.5000 49.9723
CONIP-CONIP-CONSULT, ITDS PHONE 21 15.750000 393.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 670 9514.500000 475526.0000 49.9791
INTR-T1013-INTERPRETER 1 2.000000 200.0000 100.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1029 12522.50000 125225.0000 10.0000
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
TRAV-TRAVS-Travel by mile 883 181065.0000 80568.9000 0.4450
Subtotal (Total Children Is Unduplicated) 1033 204087.2500 733834.0300 3.5957
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Total 205066.250952 794341.8121 3.8736
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Number of Children (Unduplicated) With at Least One Service 1036
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Center 53
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 7925 53881.171400 100265.0500 100265.0500
T 17780 141939.438519 221881.2640 221881.2700
8991 9236.641033 472105.4981 0.0000
Other 9 9.000000 90.0000 0.0000
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Total 34705 205066.250952 794341.8121 322146.3200