CMS/EIP Fiscal Report Center: 54
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
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 55.6600 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 9 12.000000 600.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 37.500000 2081.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.000000 1050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 208.500000 11571.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 19 30.000000 2250.0000 75.0000
Subtotal (Total Children Is Unduplicated) 193 321.500000 18643.3900 57.9888
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 19.000000 2732.8500 143.8342
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 28.250000 1412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 430 385.250000 19262.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 18 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 4.250000 212.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 4.000000 200.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 545 3058.000000 152862.5000 49.9877
INTR-T1013-INTERPRETER 28 117.000000 2925.0000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 846 4818.000000 48180.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 21 62.250000 4447.1400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 21 81.000000 5786.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 42.000000 3000.4800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 758 54543.00000 24263.0800 0.4448
Subtotal (Total Children Is Unduplicated) 857 63172.00000 265645.7100 4.2051
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Total 63493.500000 284289.1000 4.4775
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Number of Children (Unduplicated) With at Least One Service 857
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Center 54
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 1.500000 83.2500 22.5000
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 6316 34509.550000 79666.9400 79666.9400
7246 28982.450000 204538.9100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 13563 63493.500000 284289.1000 79689.4400