CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 787 802.500000 29692.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1592 6758.500000 250064.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1620 7561.000000 279757.0000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 30 30.000000 759.3000 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 30 30.000000 556.5000 18.5500
EVAL-96111-DEVELOPMENTAL EVALUATION 74 84.250000 4212.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 115 135.750000 6787.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 21.000000 1575.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 27 22.500000 1687.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 36 33.500000 3106.7100 92.7376
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 47 54.500000 3024.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 109 86.500000 6487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 158 135.000000 10125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 313 383.500000 21284.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 191 190.500000 16100.5600 84.5174
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 121 122.000000 11371.2600 93.2070
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 507.0000 507.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 1114.0300 53.0490
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 62 63.000000 3176.1500 50.4151
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 59 59.000000 2996.9500 50.7958
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 42 42.000000 2144.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 649 1524.000000 97476.0100 63.9606
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 34 69.750000 3487.5000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 8.000000 400.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 64 5379.000000 134475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1100 10502.00000 525100.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1120 11007.00000 110070.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 105 599.000000 42638.8400 71.1834
OCCT-97530HM-OT SESSION BY OT ASST 34 173.500000 9924.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 77 369.000000 26102.9700 70.7398
PHY-97110HM-PT SESSION BY PT ASST 87 625.500000 35753.5800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 74 351.750000 25093.3000 71.3385
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 8.000000 457.6000 57.2000
Subtotal (Total Children Is Unduplicated) 1308 29097.50000 913752.9900 31.4031
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Total 38182.500000 1290986.0000 33.8109
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Number of Children (Unduplicated) With at Least One Service 1822
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Center 04
Flag Claims Units Chgs Paid
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R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 295 434.500000 16224.5500 0.0000
P 6476 18234.000000 431364.2100 431453.4150
D 7 5.250000 194.2500 0.0000
S 1 1.500000 55.5000 0.0000
H 2302 9508.500000 486860.6400 350.0000
T 0 0.000000 0.0000 0.0000
4316 9744.750000 340076.9800 0.0000
Other 96 239.000000 15654.8700 322.9000
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Total 13510 38182.500000 1290986.0000 432126.3150