CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 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
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.4900 56.4900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.4200 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 12.000000 162.6600 13.5550
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 19.000000 169.2400 8.9074
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 7 7.000000 67.0200 9.5743
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 26.000000 682.8500 26.2635
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 169.6800 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.000000 226.3500 17.4115
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 5 5.500000 275.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 35 68.500000 5137.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 52 123.000000 6854.2500 55.7256
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 32 49.000000 3675.0000 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 228 390.000000 21500.7500 55.1301
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 171 262.000000 19650.0000 75.0000
Subtotal (Total Children Is Unduplicated) 449 1005.000000 60581.2100 60.2798
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 8.000000 3909.2700 488.6588
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 460.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 38.500000 1925.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 11 4.750000 118.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 627 1111.750000 55575.0000 49.9888
CONIP-CONIP-CONSULT, ITDS PHONE 20 7.000000 175.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 8.500000 425.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 20 26.000000 1300.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 0.250000 12.5000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 23 30.000000 750.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 688 9687.999500 484810.9750 50.0424
INTR-T1013-INTERPRETER 1 12.000000 770.0000 64.1667
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1146 13862.00000 138610.0000 9.9993
OCCT-97530-OT SESSION BY LICENSED OT 58 641.500052 45707.6426 71.2512
OCCT-97530HM-OT SESSION BY OT ASST 10 29.000000 1658.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 20 107.000000 7586.9600 70.9062
PHY-97110HM-PT SESSION BY PT ASST 4 6.000000 342.9600 57.1600
SENS-V5264-EARMOLD 1 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 99.000000 7072.5600 71.4400
TRAV-TRAVS-Travel by mile 1047 210321.0000 93594.2700 0.4450
Subtotal (Total Children Is Unduplicated) 1149 236009.2496 845026.6876 3.5805
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Total 237014.249552 905607.8976 3.8209
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Number of Children (Unduplicated) With at Least One Service 1151
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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 6 3.008246 120.3400 119.5900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16768 122665.714981 235925.7042 235725.7000
T 10483 82827.600476 137127.6800 137127.6800
11967 31517.925849 532434.1734 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 39224 237014.249552 905607.8976 372972.9700