CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
EXIT-EXIT-EXIT ASSESSMENT 3 6.000000 300.0000 50.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
Subtotal (Total Children Is Unduplicated) 4 10.000000 561.0000 56.1000
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 12.6600 12.6600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 50 43.000000 2050.0000 47.6744
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 9 7.500000 375.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 82 61.250000 1531.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 2 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 15 13.500000 335.0000 24.8148
CONOF-CONOF-CONSULT, OT, FACE TO FACE 3 3.000000 150.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 10.500000 262.5000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 10.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 320 2044.750000 101737.5000 49.7555
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 72 213.000000 10550.0000 49.5305
INTR-T1013-INTERPRETER 4 30.000000 2400.0000 80.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1113 7551.000000 75270.0000 9.9682
OCCT-97530-OT SESSION BY LICENSED OT 2 7.000000 500.0800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 0.0000 0.0000
PHY-97110-PT SESSION BY LICENSED PT 4 24.000000 1714.5600 71.4400
SENS-V5060-BEHIND EAR HEARING AID 1 1.000000 228.0000 228.0000
SENS-V5264-EARMOLD 2 2.000000 30.6500 15.3250
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 12.000000 857.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 285.7600 71.4400
Subtotal (Total Children Is Unduplicated) 1160 10054.50000 198840.2400 19.7762
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Total 10064.500000 199401.2400 19.8123
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Number of Children (Unduplicated) With at Least One Service 1160
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Center 06
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 8395 8334.250000 166726.1500 166726.1500
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 0 0.000000 0.0000 0.0000
1742 1730.250000 32675.0900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 10137 10064.500000 199401.2400 166726.1500