CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Payclass Filters:GR
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 713 627.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 835 2052.750000 75951.7500 37.0000
Subtotal (Total Children Is Unduplicated) 1301 2679.750000 75951.7500 28.3428
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 10 10.000000 149.3000 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 10 10.000000 104.2000 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 87.5000 8.7500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 10.000000 218.4000 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 4 4.000000 91.6000 22.9000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 43.000000 3225.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 19.500000 1462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 4 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 11.500000 862.5000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 7 7.000000 319.7500 45.6786
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 102.1000 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 63 183.000000 9780.2500 53.4440
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 1856.1100 168.7373
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 191 191.000000 9550.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 3.250000 81.2500 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 328 396.000000 19800.0000 50.0000
CONIP-CONIP-CONSULT, PHONE 30 26.500000 662.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 400 3786.250000 189312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1355 15392.50000 153921.1600 9.9998
OCCT-97530-OT SESSION BY LICENSED OT 85 404.500000 28338.6400 70.0584
OCCT-97530HM-OT SESSION BY OT ASST 6 17.000000 972.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 106 432.750000 29780.2500 68.8163
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 153 820.500000 58596.5200 71.4156
Subtotal (Total Children Is Unduplicated) 1433 21481.25000 492871.3300 22.9443
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Total 24344.000000 578603.3300 23.7678
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Number of Children (Unduplicated) With at Least One Service 2034
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Center 10
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 7266 21547.250000 494607.8300 494607.8300
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
4051 2796.750000 83995.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 11317 24344.000000 578603.3300 494607.8300