CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 8 16.000000 800.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 53 95.500000 7095.0000 74.2932
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 15 30.000000 2250.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 98 169.000000 12650.2000 74.8533
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 23 39.500000 2192.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 109.500000 7894.5000 72.0959
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 63.000000 3150.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 247 557.000000 38367.3000 68.8820
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 155 270.750000 13525.0000 49.9538
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 2 3.500000 175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 76 78.500000 1962.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 14 19.000000 925.0000 48.6842
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 18.000000 900.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1251 8977.000000 448750.0000 49.9889
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 209 270.000000 13500.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 91 619.000000 6190.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 149 990.500000 69594.8000 70.2623
OCCT-97530GT-OT SESSION BY LICENSED OT 26 41.000000 2929.0400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 198 1489.250000 105954.3200 71.1461
PHY-97110GT-PT SESSION BY LICENSED PT 16 41.000000 2929.0400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 3.000000 214.3200 71.4400
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 491 4065.000000 288592.7900 70.9945
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 77 156.500000 11180.3600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
TRAV-TRAVS-Travel by mile 1664 158852.0000 69272.1100 0.4361
Subtotal (Total Children Is Unduplicated) 1770 175949.0000 1039542.2400 5.9082
-----------------------------------------------------------------------------------------------------------------------
Total 176506.000000 1077909.5400 6.1069
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1847
-----------------------------------------------------------------------------------------------------------------------
Center 09
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 7854 163832.000000 569572.6300 569572.6300
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
3050 12399.500000 488071.1600 0.0000
Other 160 274.500000 20265.7500 0.0000
---------------------------------------------------------
Total 11064 176506.000000 1077909.5400 569572.6300