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
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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 25.2200 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.2600 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 25.3100 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 4 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 4.500000 249.7500 55.5000
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 9 17.500000 971.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 24 42.750000 2238.4500 52.3614
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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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 30 128.000000 6400.0000 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 4 19.000000 1357.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 25.000000 1786.0000 71.4400
TRAV-TRAVS-Travel by mile 455 43270.00000 19260.4000 0.4451
Subtotal (Total Children Is Unduplicated) 516 46817.50000 75268.7600 1.6077
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Total 46860.250000 77507.2100 1.6540
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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 3917 28886.500000 46527.4700 46527.4700
T 2048 15528.250000 26633.9500 26633.9500
435 2445.500000 4345.7900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6400 46860.250000 77507.2100 73161.4200