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
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
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 41.6100 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 6 6.000000 54.4800 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 29.8800 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 194.8100 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 83.5000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 22.4000 22.4000
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 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 4 6.500000 487.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 13 24.000000 1332.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 15.500000 1162.5000 75.0000
Subtotal (Total Children Is Unduplicated) 39 88.000000 4576.8900 52.0101
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 5.000000 245.6600 49.1320
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 458 726.250000 36300.0000 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 9 14.000000 350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 91 613.500000 30675.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 34 134.000000 6700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 912 8509.000000 85090.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 39.500000 2821.8800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 24.750000 1768.1400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 2 14.000000 1000.1600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
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) 1008 146594.7500 251343.1300 1.7145
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Total 146682.750000 255920.0200 1.7447
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Number of Children (Unduplicated) With at Least One Service 1011
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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 0 0.000000 0.0000 0.0000
S 6 149.000000 66.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 19342 146174.000000 244944.6000 244722.6000
336 359.750000 10909.1200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 19684 146682.750000 255920.0200 244722.6000