CMS/EIP Fiscal Report Center: 54
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 541 400.500000 14790.7500 36.9307
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 828 2692.000000 194.2500 0.0722
TCM-T1017TL-TARGETED CASE MANAGEMENT 263 612.250000 22283.2500 36.3957
Subtotal (Total Children Is Unduplicated) 1025 3704.750000 37268.2500 10.0596
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 15.000000 727.5000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 7.000000 61.2500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 24.1800 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 7 7.000000 152.8800 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 68.7000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 38 67.000000 3300.0000 49.2537
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 5 9.000000 675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 6 7.500000 562.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 25 39.000000 2127.5000 54.5513
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 24.000000 1800.0000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 94 191.500000 10186.5600 53.1935
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 5.000000 670.0700 134.0140
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 103 46.000000 2287.5000 49.7283
CONIF-CONIF-CONSULT, FACE TO FACE 481 778.500000 38837.5000 49.8876
CONIP-CONIP-CONSULT, PHONE 6 26.750000 668.7500 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 88.500000 4425.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 98 559.000000 27937.5000 49.9776
INTR-T1013-INTERPRETER 39 208.000000 5225.0000 25.1202
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 900 7513.000000 75100.0000 9.9960
OCCT-97530-OT SESSION BY LICENSED OT 4 11.000000 785.8400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 26 124.640520 8904.3187 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 346.000000 24718.2400 71.4400
TRAV-TRAVS-Travel by mile 592 61331.47000 27281.9600 0.4448
Subtotal (Total Children Is Unduplicated) 908 71037.86052 216841.6787 3.0525
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Total 74934.110520 264296.4887 3.5271
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Number of Children (Unduplicated) With at Least One Service 1149
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Center 54
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 2 3.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6996 27370.510000 93337.6388 93343.2000
T 6366 25780.600520 81230.0899 81230.0850
6908 21780.000000 89617.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 20272 74934.110520 264296.4887 174573.2850