CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
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 3 3.000000 47.5200 15.8400
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 115.6800 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 5 6.500000 487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 7 12.000000 666.0000 55.5000
Subtotal (Total Children Is Unduplicated) 17 32.000000 1559.6100 48.7378
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 5.000000 8900.5000 1780.1000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 37 167.000000 8250.0000 49.4012
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 14 39.000000 1950.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 71.000000 5109.1600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
Subtotal (Total Children Is Unduplicated) 53 284.000000 24353.5800 85.7520
-----------------------------------------------------------------------------------------------------------------------
Total 316.000000 25913.1900 82.0038
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 69
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 117 120.000000 14493.8000 14493.8000
190 196.000000 11419.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 307 316.000000 25913.1900 14493.8000