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
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
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-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 1 2.000000 111.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.000000 166.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 8 16.000000 888.0000 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 2 3.500000 262.5000 75.0000
Subtotal (Total Children Is Unduplicated) 30 58.500000 3670.0500 62.7359
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 10 16.000000 3274.5700 204.6606
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 42 151.500000 7575.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 25 82.000000 4100.0000 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 5 25.000000 1799.0000 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 61.000000 4389.5600 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 11.000000 791.5600 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) 474 30672.75000 61156.6200 1.9938
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Total 30731.250000 64826.6700 2.1095
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Number of Children (Unduplicated) With at Least One Service 484
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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 2407 17989.750000 37533.7000 37533.7000
1662 12741.500000 27292.9700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 4069 30731.250000 64826.6700 37533.7000