CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.250000 9.2500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1 0.250000 9.2500 37.0000
Subtotal (Total Children Is Unduplicated) 2 0.500000 18.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 87.4800 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 88.1100 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 242.3200 26.9244
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 37.0600 12.3533
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
EXIT-EXIT-EXIT ASSESSMENT 15 25.500000 1275.0000 50.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 19 38.000000 2109.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 74 163.500000 8621.4600 52.7306
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 58.000000 2900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 97 98.750000 4937.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 11.750000 293.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 186 247.000000 12350.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 159 261.750000 13087.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 111 135.500000 6775.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 85 101.750000 5087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 41.750000 2087.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 26 29.250000 1462.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 64 75.750000 3787.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 75 79.000000 3950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 25 80.000000 4000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 334 1442.500000 72082.0000 49.9702
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 80 192.750000 9637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1198 6581.000000 66530.0000 10.1094
OCCT-97530-OT SESSION BY LICENSED OT 19 54.500000 3485.9800 63.9629
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 22 89.000000 6324.0500 71.0567
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.250000 446.5000 71.4400
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 83 308.000000 20801.5800 67.5376
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 7.000000 457.5800 65.3686
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 5.500000 203.5000 37.0000
TRAV-TRAVS-Travel by mile 23 996.000000 443.0100 0.4448
Subtotal (Total Children Is Unduplicated) 1259 10913.25000 241643.1500 22.1422
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Total 11077.250000 250283.1100 22.5943
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Number of Children (Unduplicated) With at Least One Service 1277
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Center 07
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 4503 11073.750000 250114.6100 250105.6100
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
5 3.500000 168.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4508 11077.250000 250283.1100 250105.6100