CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 852 836.500000 30932.0000 36.9779
TCM-T1017TL-TARGETED CASE MANAGEMENT 2448 7036.500000 260350.5000 37.0000
Subtotal (Total Children Is Unduplicated) 2448 7873.000000 291282.5000 36.9977
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 30 32.000000 459.5200 14.3600
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 18.4600 18.4600
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 31 33.000000 330.6600 10.0200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 31 33.000000 277.5300 8.4100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 31 33.000000 693.0000 21.0000
AUDE-92585-AUD EVOKED RESPONSE (DIAG) 1 1.000000 62.6300 62.6300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 20 22.000000 484.4400 22.0200
EXIT-EXIT-EXIT ASSESSMENT 6 14.500000 725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 28.000000 2100.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 14.500000 1087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 201 350.500000 26287.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 127.500000 9562.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 102 167.000000 12525.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 182 317.500000 17621.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 165 231.000000 17325.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 19 20.000000 970.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 97.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 21 21.000000 1018.5000 48.5000
Subtotal (Total Children Is Unduplicated) 440 1500.000000 94961.9900 63.3080
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 7027.8800 638.8982
AUD-HA_FUP-AUDIOLOGY SERVICES 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 176 173.500000 8675.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PRO, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 18 11.750000 587.5000 50.0000
CONIP-CONIP-CONSULT, ITDS, PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 32 27.000000 1350.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 3 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 40 36.250000 1812.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 50 46.000000 2300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 23 15.250000 381.2500 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 868 8423.750000 421067.5000 49.9858
INTR-INTR-INTERPRETER 6 40.500000 2025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 219 1435.000000 95727.7700 66.7092
OCCT-97530HM-OT SESSION BY OT ASST 14 64.250000 3245.6200 50.5155
PHY-97110-PT SESSION BY LICENSED PT 235 1355.500000 90065.5300 66.4445
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 347 2274.750000 152407.5700 66.9997
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 14 56.000000 3041.9200 54.3200
TRAV-FLAT-PROV TRAVEL TO NATL ENV $10 PER CHILD 1088 14105.00000 141050.0000 10.0000
Subtotal (Total Children Is Unduplicated) 1257 28089.25000 931119.7900 33.1486
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Total 37462.250000 1317364.2800 35.1651
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Number of Children (Unduplicated) With at Least One Service 2519
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Center 10
Flag Claims Units Chgs Paid
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R 73 42.000000 1554.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7538 4779.500000 185113.5000 0.0000
P 7431 21804.750000 589295.4200 589135.4200
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 0 0.000000 0.0000 0.0000
7590 10832.000000 541120.3600 0.0000
Other 3 4.000000 281.0000 0.0000
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Total 22635 37462.250000 1317364.2800 589135.4200