CMS/EIP Fiscal Report Center: 10
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
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7 12.500000 462.5000 37.0000
Subtotal (Total Children Is Unduplicated) 7 14.250000 462.5000 32.4561
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 58 63.000000 1197.6300 19.0100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.000000 47.2600 23.6300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 71 77.000000 1080.2500 14.0292
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 58.000000 537.7100 9.2709
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 71 77.000000 2137.7500 27.7630
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 21.000000 336.1600 16.0076
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 20 21.000000 449.8800 21.4229
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 7.000000 306.3000 43.7571
OCTH-97167-OT EVAL HIGH COMPLEXITY 35 37.000000 1831.7500 49.5068
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 15.000000 714.7000 47.6467
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 28 28.000000 1429.4000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 6 9.000000 303.9100 33.7678
Subtotal (Total Children Is Unduplicated) 155 427.000000 10979.2500 25.7125
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1596.0000 1596.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 232 238.000000 11900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 14 11.000000 550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 12.500000 312.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 204 243.000000 12150.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 6.000000 300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 12 15.500000 387.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 16 21.000000 1050.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 99 100.500000 5025.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 193 209.500000 10475.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 10 10.000000 500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 6 7.750000 193.7500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1627 14123.75000 706187.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 501 976.000000 48800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1883 19943.00000 199430.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 408 2010.750000 140144.7500 69.6977
OCCT-97530GT-OT SESSION BY LICENSED OT 42 53.750000 3712.9600 69.0783
OCCT-97530HM-OT SESSION BY OT ASST 30 71.000000 3975.4000 55.9915
OCCT-97530HMGT-OT SESSION BY OT ASST 2 1.500000 85.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 490 2470.500000 175003.2800 70.8372
PHY-97110GT-PT SESSION BY LICENSED PT 42 34.000000 2393.2400 70.3894
PHY-97110HM-PT SESSION BY PT ASST 18 42.000000 2343.6000 55.8000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 557 3353.750000 236651.9700 70.5634
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 92 125.500000 8930.0000 71.1554
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 34.500000 1973.4000 57.2000
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 6 8.750000 625.1000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 42 34.250000 1267.2500 37.0000
Subtotal (Total Children Is Unduplicated) 2279 44173.75000 1576330.5200 35.6848
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Total 44615.000000 1587772.2700 35.5883
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Number of Children (Unduplicated) With at Least One Service 2297
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Center 10
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 11300 29783.500000 761038.0100 760453.6500
D 8 6.500000 226.4400 0.0000
S 112 169.000000 5515.1300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5899 14656.000000 820992.6900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17319 44615.000000 1587772.2700 760453.6500