CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 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 742 1112.500000 41070.0000 36.9169
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 723 2474.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 858 2820.750000 103674.0000 36.7541
Subtotal (Total Children Is Unduplicated) 956 6407.750000 144744.0000 22.5889
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 5.000000 242.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 65.5200 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 45.8000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 9 14.500000 725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 58.000000 4350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 30 84.000000 6300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 90.000000 4995.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 21 36.500000 2737.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 24.500000 1837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 141 248.500000 13791.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 163 294.000000 21975.0000 74.7449
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 253 882.500000 58599.9600 66.4022
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 486.4300 243.2150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 106 109.750000 5487.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 292 711.250000 35550.0000 49.9824
CONIP-CONIP-CONSULT, ITDS PHONE 36 14.750000 368.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.000000 73.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 29.000000 725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 554 3129.750000 156912.5000 50.1358
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 687 5231.000000 52300.0000 9.9981
TRAV-TRAVS-Travel by mile 352 23859.00000 10620.4000 0.4451
Subtotal (Total Children Is Unduplicated) 689 33088.75000 262555.1500 7.9349
-----------------------------------------------------------------------------------------------------------------------
Total 40379.000000 465899.1100 11.5382
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 975
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 6 10.000000 551.7500 0.0000
H 1908 10236.950000 23928.3900 23928.3900
T 2116 13197.750000 23761.4700 23761.4700
13077 13091.800000 248109.2500 0.0000
Other 101 95.250000 2065.0000 0.0000
---------------------------------------------------------
Total 21261 40379.000000 465899.1100 131217.3600