CMS/EIP Fiscal Report Center: 02
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EXIT-EXIT-EXIT ASSESSMENT 22 27.000000 1350.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 22.8300 22.8300
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 337.3500 48.1929
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 36 43.000000 2116.0300 49.2100
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 2525.0900 841.6967
AUDE-V5160-DISPENSING FEE BINAURAL 1 1.000000 230.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 34.000000 1700.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 21 25.750000 1287.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 6.000000 150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 29 39.250000 1962.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 51 49.750000 2487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.500000 62.5000 25.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 31 33.250000 1662.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 201.000000 10050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 75 448.000000 22400.0000 50.0000
INTR-T1013-INTERPRETER 11 25.000000 1250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 178 764.000000 7640.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 30.750000 2099.6200 68.2803
OCCT-97530GT-OT SESSION BY LICENSED OT 10 55.000000 3551.1300 64.5660
PHY-97110-PT SESSION BY LICENSED PT 19 38.250000 2406.2000 62.9072
PHY-97110GT-PT SESSION BY LICENSED PT 12 39.250000 2620.7900 66.7717
SENS-V5140-BEHIND EAR BINAURAL HEARING AID 1 1.000000 456.0000 456.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 182.000000 12977.9300 71.3073
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 19 120.500000 8508.5200 70.6101
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 25 31.250000 1156.2500 37.0000
TRAV-TRAVS-Travel by mile 40 3122.000000 1388.9800 0.4449
Subtotal (Total Children Is Unduplicated) 325 5262.500000 88884.0100 16.8901
-----------------------------------------------------------------------------------------------------------------------
Total 5305.500000 91000.0400 17.1520
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 335
-----------------------------------------------------------------------------------------------------------------------
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 1333 2261.750000 52752.7500 52752.7500
1099 3043.750000 38247.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2432 5305.500000 91000.0400 52752.7500