CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 25.2200 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 24.7800 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 27.1800 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 75.9300 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 37.1000 18.5500
EXIT-EXIT-EXIT ASSESSMENT 6 4.750000 237.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 13.500000 937.5000 69.4444
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 39.000000 2164.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 21.000000 1575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 69 129.000000 7104.0000 55.0698
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 37 60.500000 4498.5000 74.3554
Subtotal (Total Children Is Unduplicated) 133 295.750000 17832.2100 60.2949
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 16 14.250000 712.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 235 300.250000 15012.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 1.000000 25.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 317 1916.500000 95825.0000 50.0000
INTR-T1013-INTERPRETER 1 4.000000 140.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 516 3055.000000 30550.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 101.000000 7215.4400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 343.2000 57.2000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 42.000000 3000.4800 71.4400
TRAV-TRAVS-Travel by mile 455 43270.00000 19260.4000 0.4451
Subtotal (Total Children Is Unduplicated) 516 48713.00000 172159.5200 3.5342
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Total 49008.750000 189991.7300 3.8767
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Number of Children (Unduplicated) With at Least One Service 517
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Center 53
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 3989 28958.750000 51065.5700 51065.5700
T 2077 15559.750000 28349.9900 28349.9900
2380 4490.250000 110576.1700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8446 49008.750000 189991.7300 79415.5600