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
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 844 752.250000 27833.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 348 472.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 745 1221.250000 45078.2500 36.9116
Subtotal (Total Children Is Unduplicated) 918 2445.750000 72911.5000 29.8115
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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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.500000 412.5000 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 6 11.000000 610.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 107.500000 8062.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 98.000000 7350.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 65 125.500000 6965.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 35.500000 2662.5000 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 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 178 456.500000 29809.9800 65.3012
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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 160 888.750000 44437.5000 50.0000
INTR-T1013-INTERPRETER 29 83.000000 4150.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 436 3003.000000 30030.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 153.750000 10983.9000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 24 102.500000 6391.4700 62.3558
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 419.250000 29407.9000 70.1441
TRAV-TRAVS-Travel by mile 328 20788.00000 9252.5200 0.4451
Subtotal (Total Children Is Unduplicated) 643 25609.25000 143084.5700 5.5872
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Total 28511.500000 245806.0500 8.6213
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Number of Children (Unduplicated) With at Least One Service 1055
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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 4673 10807.750000 115523.9000 114837.7190
180 730.750000 7533.3000 0.0000
Other 5488 16973.000000 122748.8500 0.0000
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Total 10341 28511.500000 245806.0500 114837.7190