CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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
Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 12.6100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.2600 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 25.3100 25.3100
EXIT-EXIT-EXIT ASSESSMENT 28 35.500000 1775.0000 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 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 28.000000 2100.0000 75.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 62 123.500000 7314.6300 59.2278
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 75.7800 37.8900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 27.500000 1375.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 57 42.750000 2137.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 7.250000 362.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 13.000000 650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 75 472.000000 23600.0000 50.0000
INTR-T1013-INTERPRETER 26 75.000000 3750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 434 3001.000000 30010.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 108.500000 7751.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 52.750000 3768.4600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 129.000000 9215.7600 71.4400
TRAV-TRAVS-Travel by mile 160 6456.000000 2873.4900 0.4451
Subtotal (Total Children Is Unduplicated) 496 10389.25000 85632.2300 8.2424
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Total 10512.750000 92946.8600 8.8413
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Number of Children (Unduplicated) With at Least One Service 500
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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 4232 9904.500000 88566.0200 88298.0490
132 608.250000 4380.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4364 10512.750000 92946.8600 88298.0490