CMS/EIP Fiscal Report Center: 54
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 617 506.500000 18740.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 893 2927.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1254 3551.000000 131257.5000 36.9635
Subtotal (Total Children Is Unduplicated) 1326 6985.250000 149998.0000 21.4735
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 17.5000 8.7500
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 8.0600 8.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 43.6800 21.8400
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
EXIT-EXIT-EXIT ASSESSMENT 23 45.500000 2275.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 29.500000 2212.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 19.500000 1462.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 33.000000 1831.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 114 192.500000 14400.0000 74.8052
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 100.000000 7500.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 23.500000 1762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 138 232.000000 12820.5000 55.2608
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 109.000000 8175.0000 75.0000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 287 826.000000 54862.1900 66.4191
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 56.000000 8864.7600 158.2993
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 74 37.250000 1862.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 558 865.250000 43262.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 19 7.000000 149.2500 21.3214
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 11 11.000000 550.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 58.000000 2900.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 820 4458.000000 222860.0000 49.9910
INTR-T1013-INTERPRETER 33 115.500000 2887.5000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 993 7793.000000 77920.0000 9.9987
OCCT-97530-OT SESSION BY LICENSED OT 13 56.000000 4000.6400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 23 106.000000 7572.6400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 135.750000 9697.9800 71.4400
TRAV-TRAVS-Travel by mile 636 51190.00000 22786.7400 0.4451
Subtotal (Total Children Is Unduplicated) 994 64890.75000 405364.5100 6.2469
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Total 72702.000000 610224.7000 8.3935
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Number of Children (Unduplicated) With at Least One Service 1338
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Center 54
Flag Claims Units Chgs Paid
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R 3 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4712 3815.000000 163983.5000 50.0000
P 673 683.750000 35808.7500 35824.5000
D 0 0.000000 0.0000 0.0000
S 4 3.250000 47.9000 0.0000
H 3456 22299.480000 52549.5100 52549.5100
T 4177 25306.750000 56429.4400 56429.4400
16134 20589.020000 301229.8500 88404.0700
Other 4 2.750000 101.7500 0.0000
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Total 29163 72702.000000 610224.7000 233257.5200