CMS/EIP Fiscal Report Center: 02
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
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
BEHV-H2014BA-BEHAVIOR ANALYSIS-ASSOCIATE 3 19.000000 918.2000 48.3263
EXIT-EXIT-EXIT ASSESSMENT 25 30.500000 1525.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 52.000000 3798.4600 73.0473
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 25 49.000000 3675.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 73.6600 36.8300
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 15.5000 15.5000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 89 193.000000 12005.4600 62.2045
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 9.000000 7634.3400 848.2600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 31 45.000000 2250.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.500000 12.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 71 59.250000 2962.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 5.750000 143.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 15.000000 750.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 11.000000 806.5200 73.3200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 98 587.000000 29350.0000 50.0000
INTR-T1013-INTERPRETER 20 59.000000 2950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 531 3886.000000 38860.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 29 141.750000 9593.6400 67.6800
PHY-97110-PT SESSION BY LICENSED PT 16 79.000000 4716.2300 59.6991
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 67 421.500000 29934.0600 71.0179
TRAV-TRAVS-Travel by mile 185 10703.00000 4763.8300 0.4451
Subtotal (Total Children Is Unduplicated) 596 16029.75000 135002.3700 8.4220
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Total 16222.750000 147007.8300 9.0618
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Number of Children (Unduplicated) With at Least One Service 598
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Center 02
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 4 4.000000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 5672 15150.250000 140812.5700 138973.7400
341 1036.500000 6041.9000 0.0000
Other 4 32.000000 113.3600 0.0000
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Total 6021 16222.750000 147007.8300 138973.7400