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
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-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-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 22 46.000000 3450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 17 34.000000 2550.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 12 22.500000 1687.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 27 46.500000 2580.7500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 67.000000 3350.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 103 279.000000 17357.6000 62.2136
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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 96 151.500000 7575.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 20 31.500000 1575.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 76 84.250000 2106.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 8 9.000000 450.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 4 4.000000 200.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 7 8.000000 350.0000 43.7500
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 4 4.000000 200.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 6.250000 312.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 14.000000 700.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 6 6.000000 300.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 35.000000 1750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 372 2232.000000 111350.0000 49.8880
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 7.000000 350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 62 321.000000 3210.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 64 308.500000 22127.7000 71.7267
PHY-97110-PT SESSION BY LICENSED PT 55 286.000000 20580.5600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 16.000000 1151.3600 71.9600
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 149 774.500000 55733.0200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 8.000000 575.6800 71.9600
TRAV-TRAVS-Travel by mile 1219 105427.0000 46006.0500 0.4364
Subtotal (Total Children Is Unduplicated) 1348 109740.5000 277862.9000 2.5320
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Total 110019.500000 295220.5000 2.6833
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Number of Children (Unduplicated) With at Least One Service 1393
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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 2831 69986.500000 207570.4200 207570.4200
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 1527 40000.500000 85036.8900 85036.8900
4 7.000000 768.9400 0.0000
Other 13 25.500000 1844.2500 0.0000
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Total 4375 110019.500000 295220.5000 292607.3100