CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 16.000000 776.0000 48.5000
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 3.000000 51.5500 17.1833
AUDE-92586-AUD EVOKED RESPONSE (LIMITED) 1 2.000000 59.0600 29.5300
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 187 371.500000 18462.5000 49.6972
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 483.8500 64.5133
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 310.8000 47.8154
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 99 171.500000 12141.9200 70.7984
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 213 351.000000 19078.8400 54.3557
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 46 78.000000 5700.0000 73.0769
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 2.000000 58.2000 29.1000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 164.2000 41.0500
Subtotal (Total Children Is Unduplicated) 506 1022.000000 57780.7200 56.5369
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 5095.2400 849.2067
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 35.4900 35.4900
AUDE-V5160-DISPENSING FEE BINAURAL 1 2.000000 57.0300 28.5150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 162 217.500000 10337.5000 47.5287
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 104 221.250000 11012.5000 49.7740
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.750000 68.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 96.000000 4800.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.750000 43.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 36 71.500000 3550.0000 49.6503
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 68 136.500000 6600.0000 48.3516
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 546 3003.500000 149787.5000 49.8710
INTR-T1013-INTERPRETER 98 362.500000 17937.5000 49.4828
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1495 12244.00000 122440.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 26 239.500000 15344.9900 64.0709
PHY-97110-PT SESSION BY LICENSED PT 58 365.500000 24244.3500 66.3320
PHY-97110HM-PT SESSION BY PT ASST 2 3.750000 232.2000 61.9200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 95 629.250000 39125.3800 62.1778
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
TRAV-TRAVS-Travel by mile 895 79212.00000 34014.9200 0.4294
Subtotal (Total Children Is Unduplicated) 1577 96821.75000 444867.3600 4.5947
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Total 97843.750000 502648.0800 5.1373
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Number of Children (Unduplicated) With at Least One Service 1662
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Center 01
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 21741 90006.750000 419813.3900 417113.3900
D 516 1537.000000 13518.7200 0.0000
S 184 487.750000 7364.4500 0.0000
H 3 4.500000 337.5000 0.0000
T 1401 5059.750000 28475.0800 28415.4200
22 206.000000 445.9700 0.0000
Other 412 542.000000 32692.9700 450.0000
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Total 24279 97843.750000 502648.0800 445978.8100