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
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
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) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
EXIT-EXIT-EXIT ASSESSMENT 9 12.000000 600.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 5.000000 277.5000 55.5000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 19.500000 1082.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 27 43.500000 2284.0300 52.5064
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 15.000000 2457.3800 163.8253
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 82 379.900000 18994.3500 49.9983
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 2 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 11.000000 785.8400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 19.000000 1357.3600 71.4400
TRAV-TRAVS-Travel by mile 758 54543.00000 24263.0800 0.4448
Subtotal (Total Children Is Unduplicated) 857 60336.65000 120611.4700 1.9990
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Total 60380.150000 122895.5000 2.0354
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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 0 0.000000 0.0000 0.0000
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 6124 34313.400000 69391.9200 69391.9200
4407 26066.750000 53503.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10531 60380.150000 122895.5000 69391.9200