CMS/EIP Fiscal Report Center: 54
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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 7.2000 7.2000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 24.500000 1359.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 4 7.000000 525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 20 40.000000 3000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 9 18.000000 1350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 39.500000 2192.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 90 181.000000 10045.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1462.5000 75.0000
Subtotal (Total Children Is Unduplicated) 162 360.500000 21981.3000 60.9745
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 18.000000 4129.5500 229.4194
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 28 26.000000 1300.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 60 57.750000 2887.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 29 35.250000 1762.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 15 14.750000 737.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.000000 200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 330 1415.250000 70762.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 214 531.500000 26575.0000 50.0000
INTR-T1013-INTERPRETER 9 35.500000 1242.5000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 414 1760.000000 17600.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 15 58.000000 4173.6800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 4.000000 287.8400 71.9600
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 37 200.000000 14392.0000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 20.000000 1439.2000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 20 17.750000 656.7500 37.0000
TRAV-TRAVS-Travel by mile 414 28370.00000 12619.4600 0.4448
Subtotal (Total Children Is Unduplicated) 535 32574.00000 161058.6600 4.9444
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Total 32934.500000 183039.9600 5.5577
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Number of Children (Unduplicated) With at Least One Service 603
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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 2559 18149.250000 46470.4200 46470.4200
3579 14785.250000 136569.5400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 6138 32934.500000 183039.9600 46470.4200