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
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) 4 4.000000 33.8600 8.4650
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 28.0800 9.3600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 154.3800 25.7300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 74.2000 18.5500
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 5.500000 412.5000 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 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 9.500000 527.2500 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.000000 388.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 6.000000 450.0000 75.0000
Subtotal (Total Children Is Unduplicated) 24 50.500000 2356.4900 46.6632
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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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 35 177.500000 8875.0000 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 4 9.270436 662.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 36.000000 2571.8400 71.4400
TRAV-TRAVS-Travel by mile 481 41237.00000 18355.4600 0.4451
Subtotal (Total Children Is Unduplicated) 556 44845.02044 77192.2300 1.7213
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Total 44895.520436 79548.7200 1.7719
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1763 12471.250000 21376.6300 21176.6300
T 2442 18178.000000 31097.4700 31097.4700
2066 14246.270436 27074.6200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6271 44895.520436 79548.7200 52274.1000