CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
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
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 26 37.750000 1887.5000 50.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 8 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 52 95.750000 5596.9900 58.4542
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 5.000000 676.4700 135.2940
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 40.500000 2025.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 42 35.500000 1775.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 14.500000 725.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 104 594.250000 29712.5000 50.0000
INTR-T1013-INTERPRETER 24 85.000000 4250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 515 3141.000000 31410.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 53.500000 3822.0400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 56.500000 4036.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 50.750000 3625.5800 71.4400
TRAV-TRAVS-Travel by mile 170 9298.000000 4136.7200 0.4449
Subtotal (Total Children Is Unduplicated) 596 13377.50000 86344.6700 6.4545
-----------------------------------------------------------------------------------------------------------------------
Total 13473.250000 91941.6600 6.8240
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 597
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 4559 13439.750000 91373.0600 91336.9100
37 33.500000 568.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4596 13473.250000 91941.6600 91336.9100