CMS/EIP Fiscal Report Center: 53
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 675 1025.750000 37446.2500 36.5062
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 629 2169.750000 786.2500 0.3624
TCM-T1017TL-TARGETED CASE MANAGEMENT 802 2515.250000 92250.2500 36.6764
Subtotal (Total Children Is Unduplicated) 919 5710.750000 130482.7500 22.8486
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 2.000000 97.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 43.6800 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 45.8000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 15 21.250000 1062.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 64.000000 4800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 43.000000 3225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 70.000000 3885.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 102 181.000000 10045.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 224.000000 16800.0000 75.0000
Subtotal (Total Children Is Unduplicated) 200 689.250000 45875.3200 66.5583
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 4759.7200 1586.5733
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 99 94.500000 4725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 5.000000 125.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 251 631.000000 31512.5000 49.9406
CONIP-CONIP-CONSULT, PHONE 29 14.000000 350.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 11.000000 806.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 16.000000 400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 596 3783.500000 189162.5000 49.9967
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 653 5468.000000 54622.0000 9.9894
TRAV-TRAVS-Travel by mile 355 36893.00000 16407.3100 0.4447
Subtotal (Total Children Is Unduplicated) 659 46919.00000 302870.5500 6.4552
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Total 53319.000000 479228.6200 8.9880
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Number of Children (Unduplicated) With at Least One Service 939
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Center 53
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1696 1575.000000 65186.0000 0.0000
P 1575 1553.000000 73303.0000 73367.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1543 9338.500000 18887.0900 18887.0900
T 4790 15155.250000 58739.4000 58739.4000
11521 25575.500000 260537.1300 111.0000
Other 127 121.250000 2557.5000 0.0000
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Total 21253 53319.000000 479228.6200 151105.2400