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
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) 6 9.000000 122.3100 13.5900
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 13.000000 115.5800 8.8908
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 38.0400 9.5100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 19.000000 516.1700 27.1668
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 174.4000 17.4400
EXIT-EXIT-EXIT ASSESSMENT 5 5.500000 275.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 11.500000 862.5000 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 2 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 23.000000 1276.5000 55.5000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 21.000000 1165.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 22.500000 1687.5000 75.0000
Subtotal (Total Children Is Unduplicated) 73 145.000000 6675.5500 46.0383
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 497.7500 165.9167
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 5 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 100 835.680000 41784.0000 50.0000
INTR-T1013-INTERPRETER 1 12.000000 770.0000 64.1667
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1146 13860.00000 138590.0000 9.9993
OCCT-97530-OT SESSION BY LICENSED OT 17 90.391096 6457.5400 71.4400
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 62.000000 4429.2800 71.4400
TRAV-TRAVS-Travel by mile 1047 210287.0000 93579.1300 0.4450
Subtotal (Total Children Is Unduplicated) 1146 226355.8211 345856.9500 1.5279
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Total 226500.821096 352532.5000 1.5564
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Number of Children (Unduplicated) With at Least One Service 1147
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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 16124 122048.571096 199339.5700 199139.5700
T 10240 82578.500000 122921.6400 122921.6400
2634 21872.750000 30261.2900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 28999 226500.821096 352532.5000 322070.4600