CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 798 704.500000 26066.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 311 412.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 152 244.250000 9037.2500 37.0000
Subtotal (Total Children Is Unduplicated) 815 1361.250000 35103.7500 25.7879
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Screening, Eval, and Assessment,Class #02
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 12.6100 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 8.2600 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 25.3100 25.3100
EXIT-EXIT-EXIT ASSESSMENT 43 57.500000 2875.0000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 14 27.500000 2062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 52.000000 2886.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.000000 2250.0000 75.0000
PSTH-97162-PT EVAL MODERATE 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) 88 193.000000 11665.1300 60.4411
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 75.7800 37.8900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 42 49.750000 2487.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 80 57.750000 2887.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 14 11.750000 587.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 65 46.250000 2312.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 106 656.500000 32825.0000 50.0000
INTR-T1013-INTERPRETER 26 75.000000 3750.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 434 3001.000000 30010.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 108.500000 7751.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 52.750000 3768.4600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 129.000000 9215.7600 71.4400
TRAV-TRAVS-Travel by mile 298 18988.00000 8451.4200 0.4451
Subtotal (Total Children Is Unduplicated) 590 23180.75000 104185.1600 4.4945
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Total 24735.000000 150954.0400 6.1029
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Number of Children (Unduplicated) With at Least One Service 960
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Center 02
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 0 0.000000 0.0000 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 4232 9904.500000 88566.0200 88298.0490
132 608.250000 4380.8400 0.0000
Other 3403 14222.250000 58007.1800 0.0000
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Total 7767 24735.000000 150954.0400 88298.0490