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
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-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 1 7.000000 341.3200 48.7600
EXIT-EXIT-EXIT ASSESSMENT 24 29.500000 1475.0000 50.0000
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 11 22.000000 1650.0000 75.0000
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 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 15.5000 15.5000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 69 136.000000 8495.9600 62.4703
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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 2 9.000000 659.8800 73.3200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 97 585.000000 29250.0000 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 18 85.750000 6125.9800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 21.500000 1535.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 193.000000 13787.9200 71.4400
TRAV-TRAVS-Travel by mile 185 10703.00000 4763.8300 0.4451
Subtotal (Total Children Is Unduplicated) 588 15683.75000 111961.6600 7.1387
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Total 15819.750000 120457.6200 7.6144
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Number of Children (Unduplicated) With at Least One Service 590
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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 5220 14757.250000 114872.7100 113671.0100
328 1028.500000 5531.5500 0.0000
Other 2 30.000000 13.3600 0.0000
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Total 5554 15819.750000 120457.6200 113671.0100