CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 14.6800 14.6800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
EXIT-EXIT-COS Exit 12 11.500000 575.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.500000 712.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
Subtotal (Total Children Is Unduplicated) 43 77.500000 4925.4300 63.5539
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 1194.2800 1194.2800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 32.750000 1637.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 26 31.000000 1550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 62 77.500000 3875.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 38 36.750000 1837.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 21.000000 1050.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 15 14.500000 725.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 28 24.750000 1237.5000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 90 539.000000 26950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 39 107.000000 5350.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 241 1586.000000 23790.0000 15.0000
INTR-T1013-INTERPRETER 16 67.500000 3375.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 162 856.000000 10272.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 106.750000 7545.0700 70.6798
OCCT-97530GT-OT SESSION BY LICENSED OT 6 23.000000 1655.0800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 13 79.250000 5702.8300 71.9600
SENS-V5264-EARMOLD 1 2.000000 36.2600 18.1300
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 43 216.750000 15337.9300 70.7632
TRAV-TRAVS-Travel by mile 109 6726.000000 2992.5000 0.4449
Subtotal (Total Children Is Unduplicated) 414 10554.00000 116350.9500 11.0243
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Total 10631.500000 121276.3800 11.4073
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Number of Children (Unduplicated) With at Least One Service 423
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Center 02
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 3790 9514.000000 105109.3000 104890.5300
604 1114.250000 15988.1100 150.0000
Other 3 3.250000 178.9700 178.9700
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Total 4397 10631.500000 121276.3800 105219.5000