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
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
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 5 5.000000 102.3400 20.4680
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 23.4900 23.4900
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 27.7400 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.8700 9.4350
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 13.000000 366.2400 28.1723
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 30.4100 15.2050
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
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 0.500000 37.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.500000 1692.7500 55.5000
Subtotal (Total Children Is Unduplicated) 39 77.500000 3606.6900 46.5379
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 4484.2200 1494.7400
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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 32 227.000000 11350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 69 531.500000 26575.0000 50.0000
INTR-T1013-INTERPRETER 1 12.000000 900.0000 75.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 304 1374.000000 13740.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 285.7600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 3 27.000000 1928.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.976444 141.1972 71.4400
SENS-V5264-EARMOLD 1 1.000000 18.0000 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) 437 23324.97644 76608.5972 3.2844
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Total 23402.476444 80215.2872 3.4276
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Number of Children (Unduplicated) With at Least One Service 463
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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 2487 13834.476444 60733.2472 60733.2500
1293 9568.000000 19482.0400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3780 23402.476444 80215.2872 60733.2500