CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2015 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 1448 3674.000000 135255.7500 36.8143
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1316 8218.250000 804.7500 0.0979
TCM-T1017TL-TARGETED CASE MANAGEMENT 1642 9097.000000 334452.2500 36.7651
Subtotal (Total Children Is Unduplicated) 1732 20989.25000 470512.7500 22.4168
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 7.000000 339.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 8.000000 83.3600 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 10.000000 87.5000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 7 9.000000 72.5400 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 12 14.000000 305.7600 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 9 9.000000 206.1000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 41 61.750000 3087.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 195.000000 14625.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 73 191.500000 14362.5000 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 27 49.000000 3750.0000 76.5306
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 122 273.000000 15151.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 81 160.000000 12000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 81.500000 6112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 18 29.000000 2175.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 454 787.500000 44011.5000 55.8876
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 505 900.500000 68475.0000 76.0411
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 729 2789.250000 185023.7400 66.3346
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 11.000000 11020.4100 1001.8555
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 254 345.250000 17268.7500 50.0181
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 9.000000 225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 644 2927.250000 148078.7500 50.5863
CONIP-CONIP-CONSULT, ITDS PHONE 149 68.250000 1731.2500 25.3663
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 16 52.000000 3812.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 32 100.000000 2500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1040 15713.50000 785650.0000 49.9984
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1119 23618.00000 235319.5000 9.9636
TRAV-A0160-*PROV TRAVEL TO NATURAL ENV-BY MIN 307 33136.00000 16584.5000 0.5005
TRAV-TRAVS-Travel by mile 764 152755.0000 67980.9670 0.4450
Subtotal (Total Children Is Unduplicated) 1161 228749.5000 1290884.2670 5.6432
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Total 252528.000000 1946420.7570 7.7077
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Number of Children (Unduplicated) With at Least One Service 1781
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Center 53
Flag Claims Units Chgs Paid
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R 315 256.500000 9441.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3523 3439.750000 154073.5000 3172.7500
P 9193 8495.250000 379236.7500 378915.3300
D 0 0.000000 0.0000 0.0000
S 3 4.000000 101.7500 0.0000
H 17465 124433.160267 217297.5620 217290.8920
T 15755 78304.500000 198400.4050 198303.8400
41150 34088.339733 979319.2900 680.5000
Other 246 235.500000 5622.5000 0.0000
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Total 87650 249257.000000 1943493.2570 798363.3120