CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2019 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
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 4 5.000000 98.5500 19.7100
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 2 2.000000 46.9800 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 8.000000 110.9600 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 118.0400 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 6.000000 59.7600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 14 16.000000 445.2800 27.8300
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 169.6800 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 167.0000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 44.8000 22.4000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.500000 862.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 17.000000 943.5000 55.5000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 38 61.500000 4612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 31 53.000000 3975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 5 8.500000 637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 185 338.500000 18786.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 22 42.000000 2331.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 56 88.500000 6637.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 340 704.000000 41397.8200 58.8037
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.000000 245.6600 49.1320
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 14 12.500000 625.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 3 2.500000 125.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 7 6.000000 150.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 458 727.250000 36350.0000 49.9828
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 163 165.000000 8250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 113 102.250000 5112.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 71 53.500000 2675.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 0.750000 18.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 86 92.250000 4612.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 49 54.000000 2700.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 18.000000 900.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 54.000000 1350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 561 6017.750000 300837.5000 49.9917
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 256 1120.250000 56012.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 912 8509.000000 85090.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 376.750000 26900.7800 71.4022
OCCT-97530GT-OT SESSION BY LICENSED OT 13 74.750000 5340.1400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 10.000000 714.4000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 10 29.250000 2089.6200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 37 245.500000 17517.0800 71.3527
PHY-97110GT-PT SESSION BY LICENSED PT 14 47.000000 3357.6800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 24 81.000000 5786.6400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 9 13.250000 490.2500 37.0000
TRAV-TRAVS-Travel by mile 865 135989.0000 60496.6600 0.4449
Subtotal (Total Children Is Unduplicated) 1034 153813.2500 627962.4900 4.0826
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Total 154517.250000 669360.3100 4.3319
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Number of Children (Unduplicated) With at Least One Service 1054
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Center 53
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 1 1.000000 50.0000 0.0000
S 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 19921 146749.034306 274920.3100 274448.3100
7389 7618.215694 394323.7000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 27317 154517.250000 669360.3100 274448.3100