CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 1 0.250000 9.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1144 1005.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2956 9166.250000 339072.0000 36.9914
Subtotal (Total Children Is Unduplicated) 2956 10171.50000 339081.2500 33.3364
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 54 56.000000 1003.5200 17.9200
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 57 59.000000 743.9900 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 55 57.000000 470.8200 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 60 62.000000 1569.2200 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 29 29.000000 537.9500 18.5500
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 5 6.000000 124.0800 20.6800
AUDE-V5010-ASSESSMENT FOR HEARING AID 6 6.000000 270.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 7 12.000000 1380.0000 115.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 41.500000 3112.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 31.000000 1720.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 389 739.000000 55425.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 166 303.500000 22762.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 150.500000 11287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 381 716.000000 39738.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 164 236.500000 17737.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 12 12.000000 612.6000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 3.000000 102.1000 34.0333
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 510.5000 46.4091
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 664 2566.500000 161555.2300 62.9477
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 9.000000 4027.0600 447.4511
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 235 212.500000 10625.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.250000 181.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 281 269.750000 13487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 9 11.000000 275.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 27 26.500000 1325.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 61 60.250000 3012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 372 358.250000 17912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 12.000000 300.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1602 16740.25000 836862.5000 49.9910
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1729 20931.00000 209310.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 168 998.500000 69884.2400 69.9892
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 224 1490.750000 104824.5800 70.3167
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 5 9.000000 2052.0000 228.0000
SENS-V5264-EARMOLD 6 13.000000 234.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 250 1647.500000 117231.9500 71.1575
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.500000 34.7000 13.8800
Subtotal (Total Children Is Unduplicated) 1900 42802.00000 1391751.3000 32.5160
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Total 55540.000000 1892387.7800 34.0725
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Number of Children (Unduplicated) With at Least One Service 3307
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Center 10
Flag Claims Units Chgs Paid
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R 31 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8880 7014.750000 295890.0000 0.0000
P 10101 30946.250000 770962.8300 770962.8300
D 43 25.250000 934.2500 0.0000
S 10 17.750000 1204.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9814 17521.000000 822840.9500 60.0000
Other 0 0.000000 0.0000 0.0000
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Total 28879 55540.000000 1892387.7800 771022.8300