CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2023 ending 06/30/2024 Date of Report:04/12/2025 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 0.000000 0.0000 0.0000
AUDE-92550-TYMPANOMETRY & REFLEX THRESH 2 2.000000 31.6800 15.8400
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 5.000000 44.0500 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 10.000000 280.2000 28.0200
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 27.6200 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
EXIT-EXIT-COS Exit 4 7.000000 350.0000 50.0000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 10 16.000000 1200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 14 24.000000 1800.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 5 9.500000 527.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 51 92.000000 5106.0000 55.5000
Subtotal (Total Children Is Unduplicated) 98 193.500000 11023.6300 56.9697
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 9.000000 1090.6700 121.1856
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 12 9.500000 475.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 10 8.750000 437.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 0.750000 18.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 4 5.000000 250.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 4.750000 118.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 61 93.000000 4650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 39.250000 1962.5000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 3 4.250000 212.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 127 1279.250000 63662.5000 49.7655
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 55 173.500000 8675.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 423 5000.000000 75000.0000 15.0000
INTR-T1013-INTERPRETER 8 11.000000 449.7100 40.8827
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 267 2148.000000 25776.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 108.543090 7810.7600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 2 1.500000 107.9400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 6 54.000000 3885.8400 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 648 102352.0000 45531.2200 0.4448
Subtotal (Total Children Is Unduplicated) 676 111314.0431 240611.6000 2.1616
-----------------------------------------------------------------------------------------------------------------------
Total 111507.543090 251635.2300 2.2567
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 716
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 71.9600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 16178 111506.543090 251563.2700 222660.8400
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16179 111507.543090 251635.2300 222660.8400