CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 06/30/2018 Date of Report:08/10/2018 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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 51.3500 51.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 37.8300 12.6100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 115.6400 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 9 9.000000 81.5400 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.000000 354.3400 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 111.3000 18.5500
EXIT-EXIT-EXIT ASSESSMENT 17 16.750000 837.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 40 86.500000 6412.5000 74.1329
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 77 172.000000 9546.0000 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 40 63.500000 4762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 276 483.000195 26751.0109 55.3851
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 136 217.500000 16273.5000 74.8207
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 488 1115.750195 67469.0609 60.4697
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 11.000000 1464.0000 133.0909
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 58 61.250000 3062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 641 1126.500000 56325.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 22 5.750000 143.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 11.000000 275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 696 8814.250000 440712.5000 50.0000
INTR-T1013-INTERPRETER 5 22.250000 1337.5000 60.1124
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1096 13200.00000 131990.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 20 304.959991 21786.3414 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 5 19.000000 1086.8000 57.2000
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 101.000000 7215.4400 71.4400
TRAV-TRAVS-Travel by mile 976 202260.0000 90028.8100 0.4451
Subtotal (Total Children Is Unduplicated) 1100 225944.7100 755664.3914 3.3445
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Total 227060.460186 823133.4523 3.6252
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Number of Children (Unduplicated) With at Least One Service 1103
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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 1 1.000000 75.0000 75.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16101 121571.351483 209141.6000 209141.6000
T 9092 68617.726819 122397.9928 122388.0000
11282 36854.881884 490634.3595 0.0000
Other 12 15.500000 884.5000 0.0000
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Total 36488 227060.460186 823133.4523 331604.6000