CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 ending 09/30/2018 Date of Report:11/06/2018 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) 3 3.000000 37.8300 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 42.1200 8.4240
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 37.1400 9.2850
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 179.6900 25.6700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 92.7500 18.5500
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 21.000000 1575.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 31.500000 1748.2500 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 13.500000 1012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 95.500000 5244.7500 54.9188
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 80.000000 6000.0000 75.0000
Subtotal (Total Children Is Unduplicated) 109 273.000000 16532.5300 60.5587
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 116.4000 116.4000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 11 10.250000 512.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 266 296.750000 14837.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 1.250000 31.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 348 1841.500000 92075.0000 50.0000
INTR-T1013-INTERPRETER 1 8.000000 560.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 556 3068.000000 30670.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 21 124.999996 8929.9996 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 51.000000 3643.4400 71.4400
TRAV-TRAVS-Travel by mile 481 41237.00000 18355.4600 0.4451
Subtotal (Total Children Is Unduplicated) 556 46645.75000 169881.5496 3.6420
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Total 46918.749996 186414.0796 3.9731
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Number of Children (Unduplicated) With at Least One Service 557
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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 2 1.088400 54.4200 54.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1772 12481.750000 21812.9200 21612.9200
T 2444 18181.000000 31258.4700 31258.4700
3989 16254.911596 133288.2696 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8207 46918.749996 186414.0796 52925.8100