CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 706 608.000000 22488.7500 36.9881
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 392 484.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 694 1172.750000 43391.7500 37.0000
Subtotal (Total Children Is Unduplicated) 809 2264.750000 65880.5000 29.0895
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 12.6100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.2600 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 25.3100 25.3100
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 33 39.500000 1975.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 61 115.000000 8520.0000 74.0870
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 80.000000 6000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 60 109.000000 6049.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 14 25.500000 1912.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 26.0500 26.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 164 397.500000 25982.4300 65.3646
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 13.000000 15332.3400 1179.4108
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 56 72.000000 3600.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 58 50.750000 2537.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 3 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 18 17.250000 862.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 2.250000 56.2500 25.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 41 28.000000 1400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 135 741.500000 37075.0000 50.0000
INTR-T1013-INTERPRETER 17 59.500000 2975.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 408 2890.000000 28900.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 212.750000 14027.3600 65.9335
PHY-97110-PT SESSION BY LICENSED PT 39 166.750000 10206.2000 61.2066
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 87 676.000000 48293.4400 71.4400
TRAV-TRAVS-Travel by mile 276 15467.00000 6884.6700 0.4451
Subtotal (Total Children Is Unduplicated) 593 20400.00000 172231.5100 8.4427
-----------------------------------------------------------------------------------------------------------------------
Total 23062.250000 264094.4400 11.4514
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 955
-----------------------------------------------------------------------------------------------------------------------
Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4613 8616.750000 142349.5400 141022.2540
400 378.750000 7787.9300 0.0000
Other 5198 14066.750000 113956.9700 0.0000
---------------------------------------------------------
Total 10211 23062.250000 264094.4400 141022.2540