CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 54 56.000000 1003.5200 17.9200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 57 59.000000 743.9900 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 57.000000 470.8200 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 60 62.000000 1569.2200 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 29.000000 537.9500 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 6.000000 124.0800 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 6 6.000000 270.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 7 12.000000 1380.0000 115.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 12 12.000000 612.6000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 3.000000 102.1000 34.0333
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 510.5000 46.4091
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 96 322.000000 7784.2300 24.1746
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 9.000000 4027.0600 447.4511
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 235 212.500000 10625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 281 269.750000 13487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 26.500000 1325.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 61 60.250000 3012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 372 358.250000 17912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1602 16737.25000 836712.5000 49.9910
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1729 20931.00000 209310.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 168 998.500000 69884.2400 69.9892
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 224 1490.750000 104824.5800 70.3167
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 5 9.000000 2052.0000 228.0000
SENS-V5264-EARMOLD 6 13.000000 234.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 250 1647.500000 117231.9500 71.1575
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.500000 34.7000 13.8800
Subtotal (Total Children Is Unduplicated) 1900 42799.00000 1391601.3000 32.5148
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Total 43121.000000 1399385.5300 32.4525
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Number of Children (Unduplicated) With at Least One Service 1915
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Center 10
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 10101 30946.250000 770962.8300 770962.8300
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
3447 12174.750000 628422.7000 60.0000
Other 0 0.000000 0.0000 0.0000
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Total 13548 43121.000000 1399385.5300 771022.8300