CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 Page: 1
List order: No List
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 1042 1650.500000 61013.0000 36.9664
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 36 35.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1136 2534.500000 93776.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1341 4220.250000 154789.5000 36.6778
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.4400 28.7200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.7100 13.7100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
AUDE-92652-AEP THRSHLD EST MLT FREQ I&R 1 1.000000 74.6000 74.6000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.500000 187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 12.500000 693.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 16.000000 1200.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 77 144.000000 10800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 135.000000 10125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 57 101.000000 7575.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 37.000000 2053.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 176 330.500000 18334.5000 55.4750
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 24 43.000000 3225.0000 75.0000
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 315.4200 52.5700
Subtotal (Total Children Is Unduplicated) 255 891.000000 58937.0600 66.1471
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 2627.7900 525.5580
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 13 8.500000 425.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 15 15.250000 762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 5.000000 250.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 141 94.000000 4700.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 23 23.250000 1162.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 101 69.500000 3475.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 4 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 38 55.250000 2762.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 176 90.750000 4537.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 20.750000 1037.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 168 99.750000 4987.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 8 5.250000 131.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 293 901.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 324 1210.250000 60512.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 383 1358.500000 67925.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 500 2087.000000 20870.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 30 92.500000 6608.2000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 13 31.750000 2268.2200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 33 99.500000 7108.2800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 33 85.500000 6108.1200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 19 110.500000 7894.1200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 14 33.250000 2375.3800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 34 150.750000 10769.5800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 16 26.250000 1875.3000 71.4400
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 161.250000 11519.7000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 40 102.750000 7340.4600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 41 132.000000 9430.0800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 52 166.250000 11876.9000 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 69 70.500000 2608.5000 37.0000
TRAV-TRAVS-Travel by mile 239 14497.00000 6449.2100 0.4449
Subtotal (Total Children Is Unduplicated) 768 21818.25000 270684.5900 12.4063
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Total 26929.500000 484411.1500 17.9881
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Number of Children (Unduplicated) With at Least One Service 1428
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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 13 17.500000 1130.0100 0.0000
P 623 672.500000 36608.3800 36608.3800
D 54 45.500000 2843.5800 0.0000
S 517 275.250000 10306.5000 0.0000
H 52 49.750000 2252.5100 0.0000
T 891 6217.500000 13648.5100 13648.5100
14201 19589.000000 414579.1800 0.0000
Other 77 62.500000 3042.4800 0.0000
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Total 16428 26929.500000 484411.1500 50256.8900