CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2016 ending 06/30/2017 Date of Report:08/05/2017 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 1811 3989.500000 147385.0000 36.9432
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1647 10688.25000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 566 2500.750000 92287.2500 36.9038
Subtotal (Total Children Is Unduplicated) 2145 17178.50000 239672.2500 13.9519
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 14.9300 14.9300
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 8.000000 94.3100 11.7888
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 13 13.000000 110.8100 8.5238
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 8 8.000000 68.4800 8.5600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 13.000000 297.8000 22.9077
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 8 8.000000 169.8400 21.2300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 25.5300 25.5300
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 46.8000 46.8000
EVAL-96111-DEVELOPMENTAL EVALUATION 4 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 50 66.250000 3312.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 39 43.000000 3075.0000 71.5116
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 77 94.000000 6975.0000 74.2021
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 63 81.500000 4523.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 9.833333 737.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 17.000000 1275.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 47 83.500000 4634.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 91.259386 6844.4540 75.0000
Subtotal (Total Children Is Unduplicated) 235 564.342719 33877.0040 60.0291
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 8.000000 4171.1300 521.3913
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 266 330.000000 16462.5000 49.8864
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 5.750000 143.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 776 3282.750000 164006.0000 49.9599
CONIP-CONIP-CONSULT, ITDS PHONE 134 85.250000 2131.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 4 8.000000 400.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 30 170.000000 12464.4000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 25.500000 637.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 169 1445.404000 72270.2000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 200.0000 100.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1364 27018.50000 270115.0000 9.9974
TRAV-TRAVS-Travel by mile 883 181066.0000 80569.3500 0.4450
Subtotal (Total Children Is Unduplicated) 1364 213449.1540 623646.0800 2.9218
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Total 231191.996719 897195.3340 3.8807
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Number of Children (Unduplicated) With at Least One Service 2171
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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 287 302.000000 15849.8500 0.0000
D 36 36.000000 1823.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 7894 53850.618200 98737.3900 98737.3900
T 17642 141797.933519 214888.5940 214888.6000
46652 35195.445000 565796.1800 40494.7500
Other 10 10.000000 100.0000 0.0000
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Total 72521 231191.996719 897195.3340 354120.7400