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
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 1.000000 48.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.1000 56.1000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 87.9800 14.6633
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 22.0700 22.0700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 45.7900 7.6317
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 173.3200 28.8867
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 45.0800 45.0800
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 21.0400 21.0400
AUDE-V5010-ASSESSMENT FOR HEARING AID 3 3.000000 135.9600 45.3200
EXIT-EXIT-EXIT ASSESSMENT 2 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.500000 412.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 11 22.500000 1687.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 15 30.000000 2250.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 22 41.000000 2275.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 47 90.500000 5022.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 21.000000 1575.0000 75.0000
Subtotal (Total Children Is Unduplicated) 126 278.500000 16818.3400 60.3890
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 38 80.000000 10744.0300 134.3004
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 97 834.500000 41425.0000 49.6405
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 73 369.500000 18475.0000 50.0000
INTR-T1013-INTERPRETER 14 132.250000 5951.2500 45.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 853 8030.000000 80300.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 7 101.000000 7267.9600 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 5 21.000000 1511.1600 71.9600
SENS-V5264-EARMOLD 3 4.000000 72.3900 18.0975
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 272.250000 19591.1100 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 33.000000 2374.6800 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) 975 130233.5000 272262.4400 2.0906
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Total 130512.000000 289080.7800 2.2150
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Number of Children (Unduplicated) With at Least One Service 1010
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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 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 15802 110942.500000 248637.7300 247616.7400
2787 19569.500000 40443.0500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18589 130512.000000 289080.7800 247616.7400