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
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
EXIT-EXIT-EXIT ASSESSMENT 22 27.000000 1350.0000 50.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 27 33.000000 1653.7500 50.1136
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 807.4900 403.7450
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 7 21.500000 1535.9600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 6 28.000000 2000.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 29.000000 1906.8400 65.7531
PHY-97110GT-PT SESSION BY LICENSED PT 6 19.500000 1393.0800 71.4400
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 12 47.000000 3357.6800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 52.500000 3750.6000 71.4400
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) 310 4993.250000 68946.7000 13.8080
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Total 5026.250000 70600.4500 14.0463
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Number of Children (Unduplicated) With at Least One Service 320
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Center 02
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 1181 2125.250000 43692.6900 43692.6900
928 2901.000000 26907.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2109 5026.250000 70600.4500 43692.6900