CMS/EIP Fiscal Report Center: 09
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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
Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 231.6200 115.8100
EXIT-EXIT-EXIT ASSESSMENT 15 30.000000 1500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 8.000000 561.0000 70.1250
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 533.2500 71.1000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 118 238.500000 17887.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 79 153.500000 11512.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 80 150.500000 11287.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 65 120.000000 6660.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 83.000000 6225.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 13.000000 650.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 21 145.000000 7250.0000 50.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 12 12.000000 615.4800 51.2900
Subtotal (Total Children Is Unduplicated) 342 992.500000 66908.9000 67.4145
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 692.7800 692.7800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 111 185.000000 9250.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 31.500000 1575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 88 103.250000 2581.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 11.000000 550.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 5 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 9 10.000000 450.0000 45.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.250000 362.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 15.000000 750.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 7 7.000000 350.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 40.000000 2000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1166 8665.750000 431302.2300 49.7709
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 16.000000 800.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 63 326.000000 3260.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 154 1072.500000 76996.3900 71.7915
OCCT-97530GT-OT SESSION BY LICENSED OT 2 14.000000 1007.4400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 175 1211.500000 86294.6200 71.2296
PHY-97110GT-PT SESSION BY LICENSED PT 10 71.000000 4839.5600 68.1628
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 366 2924.000000 206848.4300 70.7416
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 11 63.000000 4497.4800 71.3886
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 23.000000 1655.0800 71.9600
TRAV-TRAVS-Travel by mile 1337 132963.0000 58077.1400 0.4368
Subtotal (Total Children Is Unduplicated) 1557 147777.7500 895300.8200 6.0584
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Total 148770.250000 962209.7200 6.4678
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Number of Children (Unduplicated) With at Least One Service 1707
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Center 09
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 4284 94619.000000 394715.5400 394758.0200
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 2193 47250.000000 180208.7800 180208.7800
1998 6585.750000 365107.4000 0.0000
Other 163 315.500000 22178.0000 0.0000
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Total 8638 148770.250000 962209.7200 574966.8000