CMS/EIP Fiscal Report Center: 53
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-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 13 22.000000 1650.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 43.500000 2442.0000 56.1379
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 56 96.000000 5272.5000 54.9219
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 45 70.000000 5250.0000 75.0000
Subtotal (Total Children Is Unduplicated) 113 239.500000 14835.8600 61.9451
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 49.4300 49.4300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 8 6.500000 325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 216 260.500000 13025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.250000 12.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 409 2185.000000 109250.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 140.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 584 3010.000000 30090.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 15 53.499992 3822.0392 71.4400
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 24.000000 1714.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 534 45433.00000 20223.2700 0.4451
Subtotal (Total Children Is Unduplicated) 585 50989.49999 178970.4292 3.5099
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Total 51228.999992 193806.2892 3.7831
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Number of Children (Unduplicated) With at Least One Service 586
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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 2254 15655.287512 28278.1100 28278.1100
T 3440 28802.500000 40652.7700 40652.7700
2772 6771.212480 124875.4092 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8466 51228.999992 193806.2892 68930.8800