CMS/EIP Fiscal Report Center: 09
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 1573 3424.750000 126688.0000 36.9919
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 716 675.250000 71.4400 0.1058
TCM-T1017TL-TARGETED CASE MANAGEMENT 1622 5427.250000 200789.7500 36.9966
Subtotal (Total Children Is Unduplicated) 1809 9527.250000 327549.1900 34.3802
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Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 101 196.750000 9837.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 20.000000 1397.5200 69.8760
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 18.000000 1197.5200 66.5289
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 18.000000 934.0000 51.8889
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 159 245.500000 17834.6900 72.6464
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 115 155.000000 11266.5200 72.6872
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 170 275.000000 20547.5200 74.7183
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 223 347.000000 18712.0200 53.9251
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 154 231.500000 16757.3000 72.3857
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 2.000000 100.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 34 168.000000 8400.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 536 1703.750000 109035.6400 63.9974
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 154 233.250000 11662.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 36.750000 918.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 41 74.250000 3712.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 19 26.000000 1300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 39 53.250000 2662.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 5 9.000000 225.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 53 90.000000 4500.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 6.500000 162.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1075 7665.250000 383262.5000 50.0000
INTR-T1013-INTERPRETER 103 284.250000 13992.5000 49.2260
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 73 461.000000 4610.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 124 958.000000 66269.5500 69.1749
PHY-97110-PT SESSION BY LICENSED PT 193 1468.000000 103506.9400 70.5088
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 385 3418.000000 236706.5200 69.2529
TRAV-TRAVS-Travel by mile 1345 139624.0000 61789.6100 0.4425
Subtotal (Total Children Is Unduplicated) 1539 154415.5000 895873.3700 5.8017
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Total 165646.500000 1332458.2000 8.0440
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Number of Children (Unduplicated) With at Least One Service 1889
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Center 09
Flag Claims Units Chgs Paid
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R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 220 191.750000 7419.7500 27.7500
P 19123 153422.250000 853274.4300 853432.8300
D 7 10.000000 671.0700 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2924 11777.000000 453023.7000 163.9600
Other 160 242.000000 17939.7500 0.0000
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Total 22436 165646.500000 1332458.2000 853624.5400