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
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 742 1111.750000 41042.2500 36.9168
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 723 2474.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 225 609.250000 22366.5000 36.7115
Subtotal (Total Children Is Unduplicated) 920 4195.500000 63408.7500 15.1135
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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 2 2.000000 43.6800 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 18 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 24 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 18.000000 999.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 16 29.500000 2212.5000 75.0000
Subtotal (Total Children Is Unduplicated) 73 140.500000 8961.8200 63.7852
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.9800 20.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 106 107.750000 5387.5000 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 4 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 51 194.950000 9747.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 687 5229.000000 52280.0000 9.9981
TRAV-TRAVS-Travel by mile 352 23853.00000 10617.7200 0.4451
Subtotal (Total Children Is Unduplicated) 688 30122.95000 114302.0200 3.7945
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Total 34458.950000 186672.5900 5.4172
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Number of Children (Unduplicated) With at Least One Service 957
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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 1 1.250000 0.0000 0.0000
H 1908 10236.950000 23928.3900 23928.3900
T 2116 13197.750000 23761.4700 23761.4700
11042 10927.750000 136917.7300 0.0000
Other 101 95.250000 2065.0000 0.0000
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Total 15168 34458.950000 186672.5900 47689.8600