CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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 855 1109.000000 40972.2500 36.9452
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 814 2559.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 242 714.000000 26316.2500 36.8575
Subtotal (Total Children Is Unduplicated) 1074 4382.500000 67288.5000 15.3539
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 73.4700 12.2450
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 41.3000 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 27.1800 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 4 4.000000 97.7700 24.4425
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 59.6900 19.8967
EVAL-96111-DEVELOPMENTAL EVALUATION 3 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 14 18.500000 925.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 22 33.000000 2475.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 12 20.000000 1054.5000 52.7250
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 31.081231 2331.0923 75.0000
Subtotal (Total Children Is Unduplicated) 73 168.581231 9950.5023 59.0250
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2191.7600 1095.8800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 81 78.000000 3900.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 2.750000 68.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 320 742.750000 37075.0000 49.9159
CONIP-CONIP-CONSULT, ITDS PHONE 34 22.000000 550.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 41.000000 3006.1200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 247.941200 12397.0600 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 744 5709.000000 57060.0000 9.9947
TRAV-TRAVS-Travel by mile 362 32802.00000 14575.5900 0.4444
Subtotal (Total Children Is Unduplicated) 744 39651.44120 130924.2800 3.3019
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Total 44202.522431 208163.2823 4.7093
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Number of Children (Unduplicated) With at Least One Service 1111
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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 27 27.000000 1396.6400 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 3338 27265.447431 42405.0923 42405.0900
13176 16910.075000 164361.5500 17246.7500
Other 0 0.000000 0.0000 0.0000
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Total 16541 44202.522431 208163.2823 59651.8400