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
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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 8.000000 94.3100 11.7888
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 110.8100 8.5238
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.000000 68.4800 8.5600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 13.000000 297.8000 22.9077
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 169.8400 21.2300
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 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 29.000000 2175.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 53.000000 2941.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.833333 212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 10.000000 750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 50.759386 3806.9540 75.0000
Subtotal (Total Children Is Unduplicated) 115 225.092719 12250.5040 54.4243
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 8.000000 4171.1300 521.3913
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 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 88 866.959000 43347.9500 50.0000
INTR-T1013-INTERPRETER 1 2.000000 200.0000 100.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1029 12522.50000 125225.0000 10.0000
TRAV-TRAVS-Travel by mile 883 181065.0000 80568.9000 0.4450
Subtotal (Total Children Is Unduplicated) 1033 195433.7090 301487.9800 1.5427
-----------------------------------------------------------------------------------------------------------------------
Total 195658.801719 313738.4840 1.6035
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1035
-----------------------------------------------------------------------------------------------------------------------
Center 53
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7894 53850.618200 98737.3900 98737.3900
T 17642 141797.933519 214888.5940 214888.6000
2 1.250000 22.5000 0.0000
Other 9 9.000000 90.0000 0.0000
---------------------------------------------------------
Total 25547 195658.801719 313738.4840 313625.9900