CMS/EIP Fiscal Report Center: 54
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 2 2.000000 112.2000 56.1000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 14 14.000000 205.3200 14.6657
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 2 2.000000 44.1400 22.0700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 15 16.000000 125.5600 7.8475
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.000000 404.0800 28.8629
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 2 2.000000 90.1600 45.0800
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 41.2300 13.7433
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 42.0800 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 4 5.000000 226.6000 45.3200
EXIT-EXIT-EXIT ASSESSMENT 2 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 7.500000 562.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 21.500000 1612.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 31.000000 1720.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 37 73.000000 4051.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 46.500000 3487.2500 74.9946
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 87 181.500000 13612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 81.500000 6112.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 105 194.000000 10767.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 382 741.500000 41153.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 53 104.000000 7800.0000 75.0000
Subtotal (Total Children Is Unduplicated) 701 1590.500000 95701.3800 60.1706
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 44 100.000000 16029.4600 160.2946
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 111 98.750000 4937.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 207 228.000000 11400.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 78 127.000000 6350.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 30 33.500000 1675.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 17.000000 850.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 4 3.500000 175.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 14 14.000000 700.0000 50.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 646 6652.250000 332223.5000 49.9415
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 537 2750.500000 137485.0000 49.9855
INTR-T1013-INTERPRETER 14 132.250000 5951.2500 45.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 853 8030.000000 80300.0000 10.0000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 29 230.000000 16545.6000 71.9374
PHY-97110GT-PT SESSION BY LICENSED PT 11 36.000000 2588.4800 71.9022
SENS-V5264-EARMOLD 6 13.000000 235.5600 18.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 65 827.250000 59520.5900 71.9499
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 22 55.000000 3956.7600 71.9411
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 89 139.750000 5170.7500 37.0000
TRAV-TRAVS-Travel by mile 844 119693.0000 53229.1100 0.4447
Subtotal (Total Children Is Unduplicated) 1078 139187.2500 739745.8600 5.3148
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Total 140777.750000 835447.2400 5.9345
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Number of Children (Unduplicated) With at Least One Service 1307
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Center 54
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 1 1.000000 50.0000 50.0000
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 17114 112325.980000 326648.5900 325498.8700
11189 28450.770000 508748.6500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 28304 140777.750000 835447.2400 325548.8700