CMS/EIP Fiscal Report Center: 57
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-92550-TYMPANOMETRY & REFLEX THRESH 1 1.000000 13.8000 13.8000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.0200 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 29.3600 14.6800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 17 17.000000 873.9700 51.4100
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 18 18.000000 925.3800 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 6.000000 342.5600 57.0933
Subtotal (Total Children Is Unduplicated) 50 70.000000 3338.6500 47.6950
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 65 68.000000 3400.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 61 60.250000 3012.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 5.000000 250.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 7 8.000000 400.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 45.250000 2262.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 89 91.000000 4550.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 279.000000 6975.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 6 34.000000 1700.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 998 6557.250000 327862.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 72 214.000000 10700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1020 7594.000000 75940.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 298.458459 21392.0700 71.6752
OCCT-97530HM-OT SESSION BY OT ASST 10 26.500000 1526.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 19 83.000002 5972.6800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.500000 107.9400 71.9600
PHY-97110HM-PT SESSION BY PT ASST 17 64.500000 3712.6200 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 90 550.500445 39613.9800 71.9599
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 11.500000 827.5400 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 53.000000 3052.8000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 115.2000 57.6000
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 1 1.000000 37.0000 37.0000
TRAV-TRAVS-Travel by mile 9 1882.000000 837.4600 0.4450
Subtotal (Total Children Is Unduplicated) 1094 17929.70891 514248.1900 28.6813
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Total 17999.708906 517586.8400 28.7553
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Number of Children (Unduplicated) With at Least One Service 1100
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Center 57
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 37 56.537128 3999.8700 4076.5000
D 0 0.000000 0.0000 0.0000
S 23 63.500000 1741.7600 1741.7600
H 10 10.000000 219.9500 219.9500
T 3211 12351.707490 235515.0300 235515.0300
1481 5391.535159 272205.1100 272205.1100
Other 56 126.429129 3905.1200 3905.1200
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Total 4818 17999.708906 517586.8400 517663.4700