CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 57.8400 28.9200
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 8.000000 444.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 47.500000 2636.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 34 65.000000 3607.5000 55.5000
Subtotal (Total Children Is Unduplicated) 87 162.500000 9587.3400 58.9990
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.750000 337.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 5 7.250000 362.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 3 3.000000 150.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 246 1097.500000 54875.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 150 395.500000 19775.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 288 1109.000000 11090.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 35.000000 2518.6000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 4 6.000000 431.7600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 7 16.000000 1151.3600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 5 8.000000 575.6800 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 19 12.000000 444.0000 37.0000
TRAV-TRAVS-Travel by mile 283 18841.00000 8381.9400 0.4449
Subtotal (Total Children Is Unduplicated) 343 21544.00000 100418.3400 4.6611
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Total 21706.500000 110005.6800 5.0679
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Number of Children (Unduplicated) With at Least One Service 392
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Center 53
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 1312 11432.500000 17440.2000 17440.2000
2553 10274.000000 92565.4800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3865 21706.500000 110005.6800 17440.2000