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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 814 1183.500000 43660.0000 36.8906
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 811 2659.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 951 3228.750000 118751.5000 36.7794
Subtotal (Total Children Is Unduplicated) 1050 7071.250000 162411.5000 22.9679
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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 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 10 18.000000 1350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 93.500000 5133.7500 54.9064
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 30 50.000000 3712.5000 74.2500
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 34.000000 2550.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 195 337.000000 18703.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 222 392.500000 29287.5000 74.6178
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 324 1099.000000 72875.4600 66.3107
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 486.4300 243.2150
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 107 110.750000 5537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 293 712.750000 35625.0000 49.9825
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 557 3136.750000 157262.5000 50.1355
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 761 5375.000000 53740.0000 9.9981
TRAV-TRAVS-Travel by mile 380 24540.00000 10923.5300 0.4451
Subtotal (Total Children Is Unduplicated) 763 33923.25000 264773.2800 7.8051
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Total 42093.500000 500060.2400 11.8797
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Number of Children (Unduplicated) With at Least One Service 1069
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Center 53
Flag Claims Units Chgs Paid
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R 152 114.250000 4374.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2240 2067.250000 89376.7500 111.0000
P 2054 2002.750000 93589.7500 93534.2500
D 0 0.000000 0.0000 0.0000
S 6 10.000000 551.7500 0.0000
H 1943 10442.950000 24410.8500 24410.8500
T 2147 13525.250000 24171.9700 24171.9700
13747 13835.800000 261520.1700 0.0000
Other 101 95.250000 2065.0000 0.0000
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Total 22390 42093.500000 500060.2400 142228.0700