CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2021 ending 06/30/2022 Date of Report:08/08/2022 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 3 3.500000 129.5000 37.0000
Subtotal (Total Children Is Unduplicated) 3 3.500000 129.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 6 6.000000 125.8400 20.9733
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 42.3200 14.1067
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.8700 9.4350
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 14 16.000000 452.4000 28.2750
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.4100 15.2050
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
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 24 46.500000 2580.7500 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 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 78 141.500000 10612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 38 63.000000 3496.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 236 416.500000 23115.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 417 761.000000 44863.0700 58.9528
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 7.000000 7104.6200 1014.9457
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 11.750000 587.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 3 3.000000 150.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 19.000000 950.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 6.000000 300.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.500000 37.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 24.500000 1225.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 16 22.000000 1100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 6 6.000000 150.0000 25.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.500000 25.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 0.250000 6.2500 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 310 1685.500000 84275.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 542 5685.000000 284237.0000 49.9977
INTR-T1013-INTERPRETER 1 14.000000 1050.0000 75.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 304 1374.000000 13740.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 71.250000 5090.1000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 13 59.750000 4268.5400 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 12 47.500000 3393.4000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 22 192.000000 13716.4800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 6 19.000000 1357.3600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 6.000109 428.6479 71.4400
SENS-V5264-EARMOLD 2 5.000000 90.0000 18.0000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 82 82.500000 3052.5000 37.0000
TRAV-TRAVS-Travel by mile 291 20961.00000 9324.9700 0.4449
Subtotal (Total Children Is Unduplicated) 742 30309.50011 435872.3679 14.3807
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Total 31074.000109 480864.9379 15.4748
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Number of Children (Unduplicated) With at Least One Service 976
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2813 14164.931244 77667.3672 77667.3700
8418 16909.068865 403197.5707 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11231 31074.000109 480864.9379 77667.3700