CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.500000 18.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1 0.500000 18.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 97.0900 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 72.6400 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 166.9800 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 50.1000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 22.4000 22.4000
EXIT-EXIT-EXIT ASSESSMENT 55 89.250000 4462.5000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 8.000000 550.0000 68.7500
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 22.500000 1248.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 521.2800 43.4400
Subtotal (Total Children Is Unduplicated) 99 180.750000 8750.5400 48.4124
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2778.8700 1389.4350
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 82.000000 4100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 119 248.000000 12400.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 27.000000 1350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 38.750000 1937.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 63.500000 3175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 376 2061.250000 102001.9200 49.4855
INTR-T1013-INTERPRETER 3 30.000000 2620.0000 87.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1264 7935.000000 79350.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 99.500000 6413.2800 64.4551
PHY-97110-PT SESSION BY LICENSED PT 12 80.000000 4806.0400 60.0755
PHY-97110HM-PT SESSION BY PT ASST 1 3.500000 4.9400 1.4114
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 442.000000 29773.0700 67.3599
TRAV-TRAVS-Travel by mile 12 817.000000 363.4800 0.4449
Subtotal (Total Children Is Unduplicated) 1267 11939.50000 251324.1000 21.0498
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Total 12120.750000 260093.1400 21.4585
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Number of Children (Unduplicated) With at Least One Service 1268
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Center 07
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 3886 12062.250000 256102.0800 255887.7600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
23 58.500000 3991.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3909 12120.750000 260093.1400 255887.7600