CMS/EIP Fiscal Report Center: 54
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 2.000000 396.8000 198.4000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 5.000000 73.4000 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 36.0000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 86.7600 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-V5010-ASSESSMENT FOR HEARING AID 2 2.000000 90.6400 45.3200
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 6.000000 450.0000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 9 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 16 34.000000 2550.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 34.500000 1914.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 69 136.000000 7548.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 18.000000 1350.0000 75.0000
Subtotal (Total Children Is Unduplicated) 133 306.500000 18460.0400 60.2285
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 14.000000 1865.1000 133.2214
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 24 19.500000 975.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 56 50.250000 2512.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 16.000000 800.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 6 6.250000 312.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 5 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 303 1269.750000 63487.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 219 565.250000 28262.5000 50.0000
INTR-T1013-INTERPRETER 8 42.750000 1851.2500 43.3041
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 385 1547.000000 15470.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 18 51.000000 3669.9600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 5.000000 359.8000 71.9600
SENS-V5264-EARMOLD 2 3.000000 54.3900 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 179.000000 12880.8400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 8.000000 575.6800 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 38 37.750000 1396.7500 37.0000
TRAV-TRAVS-Travel by mile 378 21702.00000 9634.8100 0.4440
Subtotal (Total Children Is Unduplicated) 506 25522.75000 144421.0800 5.6585
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Total 25829.250000 162881.1200 6.3061
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Number of Children (Unduplicated) With at Least One Service 563
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Center 54
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 2257 13557.510000 39404.4100 38954.4100
3263 12271.740000 123476.7100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5520 25829.250000 162881.1200 38954.4100