CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2024 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-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.000000 26.4300 8.8100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 4.000000 106.6800 26.6700
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 13.8100 13.8100
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 30.500000 1692.7500 55.5000
Subtotal (Total Children Is Unduplicated) 29 59.500000 3214.4600 54.0245
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 4.000000 311.7700 77.9425
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.000000 150.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.500000 25.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 24.500000 1225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 16.000000 800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 70 439.000000 21950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 18 34.000000 1700.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 223 1260.000000 18900.0000 15.0000
INTR-T1013-INTERPRETER 3 3.500000 105.9800 30.2800
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 161 944.000000 11328.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 9 40.807400 2936.5000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 0.500000 35.9800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 19.000000 1367.2400 71.9600
TRAV-TRAVS-Travel by mile 375 31080.00000 13825.9600 0.4449
Subtotal (Total Children Is Unduplicated) 386 33873.05740 74767.6800 2.2073
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Total 33932.557400 77982.1400 2.2982
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Number of Children (Unduplicated) With at Least One Service 399
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Center 53
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 5027 33932.557400 77982.1400 50921.5800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5027 33932.557400 77982.1400 50921.5800