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
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-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.3600 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 14.4000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.3200 45.3200
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-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.500000 971.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 21 46.000000 2545.4200 55.3352
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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 39 167.000000 8350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 64.000000 3200.0000 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 6 27.000000 1942.9200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SENS-V5264-EARMOLD 1 1.000000 18.1300 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 62.000000 4461.5200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 6.000000 431.7600 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) 449 23769.75000 53606.7000 2.2552
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Total 23815.750000 56152.1200 2.3578
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Number of Children (Unduplicated) With at Least One Service 457
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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 2147 13442.500000 33095.7100 32645.7100
1468 10373.250000 23056.4100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3615 23815.750000 56152.1200 32645.7100