CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.750000 27.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.750000 27.7500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 17.9200 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 25.2200 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 16.5200 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 50.6200 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 18.5500 18.5500
EXIT-EXIT-EXIT ASSESSMENT 30 34.000000 1700.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 21 41.000000 3075.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 67 123.000000 7374.1300 59.9523
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 7.000000 12127.4000 1732.4857
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 25 30.000000 1500.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 43 32.750000 1637.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 4.000000 100.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 11.000000 550.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.500000 25.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 19.500000 975.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 3.250000 81.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 72 389.250000 19462.5000 50.0000
INTR-T1013-INTERPRETER 24 55.750000 2787.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 418 2899.000000 28990.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 71.250000 5090.1000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 62.000000 4077.7000 65.7694
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 204.000000 14573.7600 71.4400
TRAV-TRAVS-Travel by mile 157 7056.000000 3140.7900 0.4451
Subtotal (Total Children Is Unduplicated) 499 10845.25000 95118.5000 8.7705
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Total 10969.000000 102520.3800 9.3464
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Number of Children (Unduplicated) With at Least One Service 507
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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 4305 10967.250000 102421.1900 102060.5900
1 1.000000 71.4400 51.0500
Other 1 0.750000 27.7500 0.0000
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Total 4307 10969.000000 102520.3800 102111.6400