CMS/EIP Fiscal Report Center: 57
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-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 29.000000 1480.4500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 22 22.000000 1123.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 71 71.000000 3624.5500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 141 179.000000 9650.2500 53.9120
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 48.000000 2400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 158 156.500000 7825.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 438.000000 10950.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 923 7238.000000 361900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1004 8300.000000 83000.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 68 338.181700 24159.7000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 25 71.500000 4089.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 85 368.000000 26289.9200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 31 231.250000 13218.2500 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 134 639.250000 45668.0200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 24 62.000000 3546.4000 57.2000
TRAV-TRAVS-Travel by mile 31 9597.000000 4270.7700 0.4450
Subtotal (Total Children Is Unduplicated) 1162 27497.68170 587963.8600 21.3823
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Total 27676.681700 597614.1100 21.5927
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Number of Children (Unduplicated) With at Least One Service 1167
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Center 57
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 22 16.863400 1184.3300 1184.3300
D 0 0.000000 0.0000 0.0000
S 96 80.250000 3392.8200 3393.8700
H 0 0.000000 0.0000 0.0000
T 3847 21160.250000 273226.2500 273224.4200
1779 6203.318300 314946.5000 314931.1700
Other 103 216.000000 4864.2100 4904.2100
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Total 5847 27676.681700 597614.1100 597638.0000