CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2016 ending 06/30/2016 Date of Report:08/06/2016 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 760 1086.000000 40117.2500 36.9404
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 735 2625.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 916 2849.000000 104913.5000 36.8247
Subtotal (Total Children Is Unduplicated) 1047 6560.500000 145030.7500 22.1067
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 20.8400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 4.000000 35.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 4.000000 32.2400 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 4.000000 87.3600 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 68.7000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 12 18.500000 925.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 52.000000 3900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 46.500000 3487.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 38 83.500000 4634.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 23.000000 1725.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 28.000000 2100.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.500000 1237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 137 233.500000 12959.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 138 243.000000 18225.0000 75.0000
Subtotal (Total Children Is Unduplicated) 227 777.000000 50540.0700 65.0451
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 104 112.500000 5600.0000 49.7778
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 335 1086.750000 54272.5000 49.9402
CONIP-CONIP-CONSULT, ITDS PHONE 43 18.750000 468.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 0.250000 12.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 10 14.000000 700.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 37.000000 2712.8400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 51.000000 1275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 677 4751.500000 237550.0000 49.9947
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 751 7870.000000 78700.0000 10.0000
TRAV-TRAVS-Travel by mile 469 51236.00000 22806.6900 0.4451
Subtotal (Total Children Is Unduplicated) 751 65179.00000 404129.5300 6.2003
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Total 72516.500000 599700.3500 8.2698
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Number of Children (Unduplicated) With at Least One Service 1080
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Center 53
Flag Claims Units Chgs Paid
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R 157 140.500000 5158.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1471 1459.000000 69302.5000 0.0000
P 2003 1760.500000 73890.5000 73843.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8241 55897.500000 97408.6700 97402.0000
T 3784 2907.500000 45536.0300 45476.0300
12238 10349.500000 308303.9000 330.5000
Other 2 2.000000 100.0000 0.0000
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Total 27896 72516.500000 599700.3500 217052.0300