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
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 1448 3670.750000 135135.5000 36.8141
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1316 8211.250000 804.7500 0.0980
TCM-T1017TL-TARGETED CASE MANAGEMENT 447 1713.500000 63038.7500 36.7895
Subtotal (Total Children Is Unduplicated) 1660 13595.50000 198979.0000 14.6357
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 7.000000 339.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 72.9400 10.4200
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.000000 70.0000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 6 7.000000 56.4200 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 11.000000 240.2400 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 183.2000 22.9000
EXIT-EXIT-EXIT ASSESSMENT 39 59.750000 2987.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 50 56.000000 4200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 47 55.000000 4125.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 49 63.500000 3524.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 12 19.000000 1425.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 35 64.000000 3552.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 102.126667 7734.5000 75.7344
Subtotal (Total Children Is Unduplicated) 217 481.876667 29598.0500 61.4225
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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 253 337.750000 16893.7500 50.0185
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 9.000000 225.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 644 2926.250000 148028.7500 50.5865
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 6 20.000000 1466.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 30.000000 750.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 169 1126.033600 55976.6800 49.7114
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1119 23603.00000 235169.5000 9.9635
TRAV-A0160-*PROV TRAVEL TO NATURAL ENV-BY MIN 307 33136.00000 16584.5000 0.5005
TRAV-TRAVS-Travel by mile 764 152695.0000 67954.2570 0.4450
Subtotal (Total Children Is Unduplicated) 1158 213976.5336 556512.9970 2.6008
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Total 228053.910267 785090.0470 3.4426
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Number of Children (Unduplicated) With at Least One Service 1725
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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 4 3.750000 30.0000 55.5800
D 0 0.000000 0.0000 0.0000
S 1 1.250000 0.0000 0.0000
H 17465 124433.160267 217297.5620 217290.8920
T 15754 78303.500000 198350.4050 198303.8400
29233 21849.750000 363112.0800 130.5000
Other 228 216.500000 4622.5000 0.0000
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Total 62685 224807.910267 783412.5470 415780.8120