CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 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
CASE-CASE-NON-TCM CASE MANAGEMENT 373 212.750000 7871.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 347 2245.750000 34.2500 0.0153
TCM-T1017TL-TARGETED CASE MANAGEMENT 716 1819.250000 66988.5000 36.8220
Subtotal (Total Children Is Unduplicated) 770 4277.750000 74894.5000 17.5079
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 10.4200 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 2.000000 17.5000 8.7500
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.8400 21.8400
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 239.2000 119.6000
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 128 261.000000 18895.0000 72.3946
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 140.000000 10330.0000 73.7857
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 50.000000 3750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 161 318.500000 17501.2300 54.9489
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 16 21.000000 1072.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 27 27.000000 1350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 23.000000 1161.3800 50.4948
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 238 873.500000 56061.2200 64.1800
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 109 132.250000 6612.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 176 443.250000 22143.7500 49.9577
CONIP-CONIP-CONSULT, PHONE 9 9.000000 222.0000 24.6667
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 311 1668.000000 83227.5000 49.8966
INTR-T1013-INTERPRETER 7 18.000000 900.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 573 4097.000000 40970.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 67 358.250000 25368.4400 70.8121
OCCT-97530HM-OT SESSION BY OT ASST 15 89.750000 5090.9800 56.7240
PHY-97110-PT SESSION BY LICENSED PT 30 232.750000 16181.1600 69.5216
PHY-97110HM-PT SESSION BY PT ASST 6 22.500000 1286.1000 57.1600
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 212 1271.500000 86437.0700 67.9804
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 542 40572.00000 18049.3050 0.4449
Subtotal (Total Children Is Unduplicated) 628 48921.25000 306605.3250 6.2673
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Total 54072.500000 437561.0450 8.0921
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Number of Children (Unduplicated) With at Least One Service 874
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Center 52
Flag Claims Units Chgs Paid
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R 22 40.500000 3018.5000 830.0000
U 0 0.000000 0.0000 0.0000
B 1647 1580.000000 78091.7500 13382.5000
P 803 668.250000 24516.3200 24513.8200
D 0 0.000000 0.0000 0.0000
S 9 15.000000 477.1900 477.1900
H 0 0.000000 0.0000 0.0000
T 4814 43986.750000 187325.2450 176042.5600
3896 7782.000000 144132.0400 155.3200
Other 0 0.000000 0.0000 0.0000
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Total 11191 54072.500000 437561.0450 215401.3900