CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1438 1073.500000 39719.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 939 825.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1823 5200.000000 192400.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1940 7098.500000 232119.5000 32.6998
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 18 30.250000 1512.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 17.000000 1275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 16.000000 888.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 218 336.000000 25200.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 96 150.500000 11287.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 116 172.000000 12900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 230 363.000000 20146.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 7 11.500000 862.5000 75.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 151.4400 75.7200
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 369 1112.250000 75225.5400 67.6337
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 61.8900 30.9450
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 112 106.500000 5285.0000 49.6244
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 4.500000 112.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 21 23.500000 1175.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 13 10.000000 250.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 5 4.500000 225.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 19 20.000000 1000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 9.750000 243.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 281 2026.750000 99000.0000 48.8467
INTR-T1013-INTERPRETER 12 73.000000 4628.0000 63.3973
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1201 9986.000000 99640.0000 9.9780
OCCT-97530-OT SESSION BY LICENSED OT 55 223.500000 15309.4800 68.4988
OCCT-97530HM-OT SESSION BY OT ASST 8 26.750000 1529.9000 57.1925
PHY-97110-PT SESSION BY LICENSED PT 83 322.250000 20254.3900 62.8530
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 182 918.750000 63008.3000 68.5805
SPL-92508-GROUP SPL SESSION PER CHILD 14 256.500000 3164.4000 12.3368
Subtotal (Total Children Is Unduplicated) 1224 14024.00000 315243.8600 22.4789
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Total 22234.750000 622588.9000 28.0007
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Number of Children (Unduplicated) With at Least One Service 2047
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Center 06
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 8736 8266.750000 189854.9200 189854.9200
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 0 0.000000 0.0000 0.0000
18435 13968.000000 432733.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 27171 22234.750000 622588.9000 189854.9200