CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 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 2 2.000000 55.6600 27.8300
EXIT-EXIT-EXIT ASSESSMENT 4 4.500000 225.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.500000 487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 12.000000 666.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 2.500000 187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 10 13.000000 975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 53 89.500000 4934.0000 55.1285
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 58.000000 4350.0000 75.0000
Subtotal (Total Children Is Unduplicated) 112 193.000000 12073.3200 62.5561
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 2195.9000 731.9667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 17 11.250000 562.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 221 255.000000 12737.5000 49.9510
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 349 2180.750000 109037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 571 3104.000000 31040.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 36 155.250000 11055.3800 71.2102
OCCT-97530HM-OT SESSION BY OT ASST 10 29.000000 1658.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 18 80.000000 5715.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 13.000000 928.7200 71.4400
TRAV-TRAVS-Travel by mile 530 45721.00000 20339.4200 0.4449
Subtotal (Total Children Is Unduplicated) 573 51560.25000 195567.4000 3.7930
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Total 51753.250000 207640.7200 4.0121
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Number of Children (Unduplicated) With at Least One Service 574
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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 1 1.000000 10.0000 9.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3964 27489.500000 51338.9900 51338.9900
T 0 0.000000 0.0000 0.0000
4930 24262.750000 156291.7300 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8895 51753.250000 207640.7200 51348.2400