CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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) 2 2.000000 27.7400 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 27.2400 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 139.1500 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 8 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 46 82.000000 4551.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 52.000000 3900.0000 75.0000
Subtotal (Total Children Is Unduplicated) 98 216.000000 13496.2000 62.4824
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 331.9200 331.9200
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 6.500000 325.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 188 204.000000 10200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 7 3.500000 87.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 8.500000 425.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 28.000000 1300.0000 46.4286
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 328 1648.500000 82336.0000 49.9460
INTR-T1013-INTERPRETER 1 2.000000 70.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 514 2524.000000 25230.0000 9.9960
OCCT-97530-OT SESSION BY LICENSED OT 35 185.500000 12967.3200 69.9047
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 9 24.000000 1657.4400 69.0600
PHY-97110HM-PT SESSION BY PT ASST 2 6.000000 342.9600 57.1600
TRAV-TRAVS-Travel by mile 467 41723.00000 18563.8300 0.4449
Subtotal (Total Children Is Unduplicated) 516 46371.50000 154101.3700 3.3232
-----------------------------------------------------------------------------------------------------------------------
Total 46587.500000 167597.5700 3.5975
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 519
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 646 4089.500000 8241.9600 8241.9600
T 1849 13777.000000 23900.7700 23900.7700
4653 28721.000000 135454.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7148 46587.500000 167597.5700 32142.7300