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
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
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-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 4 7.500000 562.5000 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 5 10.000000 750.0000 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 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
Subtotal (Total Children Is Unduplicated) 36 65.000000 4105.8800 63.1674
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
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 90 530.000000 26500.0000 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 12 35.750000 2513.5300 70.3085
OCCT-97530GT-OT SESSION BY LICENSED OT 2 8.000000 575.6800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 6 29.500000 2122.8200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 23.500000 1678.0900 71.4081
TRAV-TRAVS-Travel by mile 109 6726.000000 2992.5000 0.4449
Subtotal (Total Children Is Unduplicated) 399 10213.00000 91319.6200 8.9415
-----------------------------------------------------------------------------------------------------------------------
Total 10278.000000 95425.5000 9.2844
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 406
-----------------------------------------------------------------------------------------------------------------------
Center 02
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 3318 9189.250000 81327.2700 81165.7600
558 1086.250000 13973.2300 150.0000
Other 2 2.500000 125.0000 125.0000
---------------------------------------------------------
Total 3878 10278.000000 95425.5000 81440.7600