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
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
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) 10 10.000000 82.6000 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 6.000000 54.3600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 227.7900 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 74.2000 18.5500
EXIT-EXIT-EXIT ASSESSMENT 17 16.750000 837.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 75.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 21.500000 1612.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 0.990223 74.2667 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 33.000000 1831.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 41 69.297297 3846.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 25.500000 1912.5000 75.0000
Subtotal (Total Children Is Unduplicated) 117 207.037520 11113.9467 53.6808
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 10.000000 1101.4500 110.1450
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 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 4 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 98 753.945000 37697.2500 50.0000
INTR-T1013-INTERPRETER 4 21.250000 1287.5000 60.5882
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1096 13198.00000 131970.0000 9.9992
OCCT-97530-OT SESSION BY LICENSED OT 10 64.536813 4610.5100 71.4400
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 59.000000 4214.9600 71.4400
TRAV-TRAVS-Travel by mile 976 202260.0000 90028.8100 0.4451
Subtotal (Total Children Is Unduplicated) 1100 217570.9818 330728.4800 1.5201
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Total 217778.019333 341842.4267 1.5697
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Number of Children (Unduplicated) With at Least One Service 1102
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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 15789 121252.351483 190908.6300 190908.6300
T 8968 68490.537520 114573.1167 114563.1200
2785 28035.130330 36360.6800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 27542 217778.019333 341842.4267 305471.7500