CMS/EIP Fiscal Report Center: 09
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 1597 4054.000000 149998.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 689 624.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1699 6246.250000 231092.7500 36.9970
Subtotal (Total Children Is Unduplicated) 1859 10924.75000 381090.7500 34.8832
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 17.9200 17.9200
AUDE-92553-PURE TONE AUDIOMETRY AIR & BONE 1 1.000000 21.3500 21.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 25.2200 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 3.000000 24.7800 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 50.6200 25.3100
EXIT-EXIT-EXIT ASSESSMENT 136 274.500000 13725.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 13.000000 975.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 211 330.500000 23952.3500 72.4731
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 59 95.500000 7080.0200 74.1363
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 171 282.000000 20838.7900 73.8964
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 225 383.500000 20480.4800 53.4041
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 166 255.000000 18663.8300 73.1915
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 18 90.000000 4500.0000 50.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 569 1786.500000 113848.0600 63.7269
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 147 260.250000 13012.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 28.500000 712.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 32 49.750000 2487.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 22 22.000000 1100.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 20.000000 1000.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 44.000000 2200.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 238 324.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1116 8012.500000 400625.0000 50.0000
INTR-T1013-INTERPRETER 114 276.750000 13627.5000 49.2412
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 73 522.000000 5220.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 110 781.000000 55170.1700 70.6404
PHY-97110-PT SESSION BY LICENSED PT 164 1356.500000 96238.1600 70.9459
SENS-V5014-*HEARING AID REPAIR BY MANUFACTURER 1 2.000000 228.0000 114.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 380 3132.000000 220907.0500 70.5323
TRAV-TRAVS-Travel by mile 1373 139228.0000 61562.0800 0.4422
Subtotal (Total Children Is Unduplicated) 1569 154064.2500 874188.9600 5.6742
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Total 166775.500000 1369127.7700 8.2094
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Number of Children (Unduplicated) With at Least One Service 1974
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Center 09
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 27 27.750000 1000.9500 50.0000
P 20019 153360.750000 904209.1400 905190.2400
D 12 17.000000 1214.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 47 88.500000 6044.1300 0.0000
T 0 0.000000 0.0000 0.0000
3060 12979.500000 434593.9100 74.4000
Other 187 302.000000 22065.0000 0.0000
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Total 23352 166775.500000 1369127.7700 905314.6400