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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 675 1025.750000 37446.2500 36.5062
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 2166.500000 786.2500 0.3629
TCM-T1017TL-TARGETED CASE MANAGEMENT 159 369.000000 13579.0000 36.7995
Subtotal (Total Children Is Unduplicated) 837 3561.250000 51811.5000 14.5487
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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) 1 1.000000 10.4200 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 14 20.250000 1012.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 17.000000 1275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 13.000000 975.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 19.000000 1054.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.000000 300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 9 17.000000 943.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 29.000000 2175.0000 75.0000
Subtotal (Total Children Is Unduplicated) 62 131.750000 8344.9000 63.3389
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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 3 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 260.750000 13037.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 652 5458.000000 54522.0000 9.9894
TRAV-TRAVS-Travel by mile 355 36893.00000 16407.3100 0.4447
Subtotal (Total Children Is Unduplicated) 655 43379.25000 126470.5500 2.9155
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Total 47072.250000 186626.9500 3.9647
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Number of Children (Unduplicated) With at Least One Service 882
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Center 53
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 1543 9338.500000 18887.0900 18887.0900
T 4790 15155.250000 58739.4000 58739.4000
8417 22457.250000 106442.9600 0.0000
Other 127 121.250000 2557.5000 0.0000
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Total 14877 47072.250000 186626.9500 77626.4900