CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 689 839.000000 31016.0000 36.9678
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 783 2635.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 945 2922.500000 107679.2500 36.8449
Subtotal (Total Children Is Unduplicated) 1064 6396.500000 138695.2500 21.6830
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 26.2500 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 16.1200 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 65.5200 21.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 22.9000 22.9000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 25.5300 25.5300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
EXIT-EXIT-EXIT ASSESSMENT 8 10.250000 512.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 40.500000 2887.5000 71.2963
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 40.500000 3037.5000 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 9 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 71.500000 3968.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 35.500000 2662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 24.000000 1800.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 20 28.500000 2137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 133 253.000000 14041.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 157 285.500000 21412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 240 816.250000 53862.8700 65.9882
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 4.000000 1364.7700 341.1925
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 73 84.500000 4225.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 0.250000 6.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 321 840.000000 42000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 21 11.000000 275.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 8.000000 400.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 55.000000 4032.6000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 657 3521.750000 176125.0000 50.0106
INTR-T1013-INTERPRETER 1 2.000000 200.0000 100.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 776 5917.000000 59150.0000 9.9966
TRAV-TRAVS-Travel by mile 406 31024.00000 13802.6900 0.4449
Subtotal (Total Children Is Unduplicated) 776 41490.50000 302181.3100 7.2831
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Total 48703.250000 494739.4300 10.1582
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Number of Children (Unduplicated) With at Least One Service 1090
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Center 53
Flag Claims Units Chgs Paid
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R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1895 1776.250000 81669.7900 0.0000
P 1900 1749.000000 77322.0000 77272.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1993 13181.750000 23633.4600 23633.4600
T 0 0.000000 0.0000 0.0000
16634 31985.000000 311940.9300 0.0000
Other 9 9.000000 90.0000 0.0000
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Total 22433 48703.250000 494739.4300 100905.4600