CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 6 12.000000 600.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 101 199.500000 14962.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 47 94.000000 7050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 80 154.500000 11587.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 66 128.000000 7104.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 13.500000 1012.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 39 77.000000 5775.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 6.000000 300.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 5.000000 250.0000 50.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 273 746.000000 52476.7000 70.3441
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 3242.0000 1621.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 139.750000 6987.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 42 90.000000 4500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 101 127.250000 3181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 14.000000 700.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 8.000000 400.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 25.000000 1250.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 3.000000 150.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 2 1.500000 75.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 14 19.000000 950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1049 8204.500000 405775.2500 49.4576
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 60 233.000000 11650.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 42 246.000000 2220.0000 9.0244
OCCT-97530-OT SESSION BY LICENSED OT 160 1146.500000 81219.7100 70.8414
OCCT-97530GT-OT SESSION BY LICENSED OT 5 21.000000 1500.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 176 1430.500000 100982.6800 70.5926
PHY-97110GT-PT SESSION BY LICENSED PT 39 206.000000 14716.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 425 3591.750000 250877.8400 69.8484
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 157.000000 11216.0800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 9.000000 642.9600 71.4400
SPL-92508HA-GROUP SPL SESSION PER CHILD 1 8.000000 111.0400 13.8800
TRAV-TRAVS-Travel by mile 1185 131191.0000 57245.7600 0.4364
Subtotal (Total Children Is Unduplicated) 1493 146898.7500 960643.9500 6.5395
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Total 147644.750000 1013120.6500 6.8619
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Number of Children (Unduplicated) With at Least One Service 1600
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Center 09
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 6081 133448.250000 544287.1600 544287.1600
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 234 6331.000000 24198.6500 24198.6500
2341 7677.000000 431625.8400 0.0000
Other 99 188.500000 13009.0000 0.0000
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Total 8755 147644.750000 1013120.6500 568485.8100