CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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 776 1076.750000 39784.2500 36.9485
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 852 2739.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1034 2987.000000 110270.2500 36.9167
Subtotal (Total Children Is Unduplicated) 1170 6803.250000 150054.5000 22.0563
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 12.6100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 16.5200 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.0600 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 75.9300 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 18.5500 18.5500
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 12 16.250000 812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 45.000000 3375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 35 93.000000 6975.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1687.5000 73.3696
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 45 97.000000 5383.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 40.500000 3037.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 14 24.500000 1837.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 28.500000 2137.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 128 227.000000 12587.5000 55.4515
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 156 297.500821 22275.0123 74.8738
SENS-V5014TS-HEARING AID REPAIR IN-OFFICE 1 1.000000 15.0000 15.0000
Subtotal (Total Children Is Unduplicated) 251 903.250821 60356.1823 66.8211
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 86 92.500000 4587.5000 49.5946
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 329 772.500000 38593.5000 49.9592
CONIP-CONIP-CONSULT, ITDS PHONE 41 18.500000 462.5000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 32.000000 2346.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 52.500000 1312.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 730 4236.000000 211737.5000 49.9852
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 810 6661.500000 66585.0000 9.9955
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 50.0000 50.0000
TRAV-TRAVS-Travel by mile 436 43208.00000 19230.5000 0.4451
Subtotal (Total Children Is Unduplicated) 810 55079.25000 345041.9900 6.2645
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Total 62785.750821 555452.6723 8.8468
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Number of Children (Unduplicated) With at Least One Service 1203
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Center 53
Flag Claims Units Chgs Paid
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R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 427 347.500000 14617.5000 1387.5000
P 3909 3733.950000 168488.0000 167638.2500
D 10 12.000000 661.0000 0.0000
S 3 2.500000 118.5000 18.5000
H 0 0.000000 0.0000 0.0000
T 6003 46545.651622 68526.6167 68526.6200
14943 12116.899199 301749.8056 0.0000
Other 31 26.750000 1272.7500 0.0000
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Total 25327 62785.750821 555452.6723 237570.8700