CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Payclass Filters:TPIN
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 3 4.750000 175.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 14 23.500000 869.5000 37.0000
Subtotal (Total Children Is Unduplicated) 17 28.250000 1045.2500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 16.5200 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 2 2.000000 18.1200 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 50.6200 25.3100
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 24.000000 1800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 35.500000 2662.5000 75.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 50 145.000000 9657.5600 66.6039
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 0.750000 37.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 125 691.128600 34568.9300 50.0181
OCCT-97530-OT SESSION BY LICENSED OT 11 65.000000 4643.6000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 17.000000 1214.4800 71.4400
Subtotal (Total Children Is Unduplicated) 139 775.378600 40464.5100 52.1868
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Total 948.628600 51167.3200 53.9382
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Number of Children (Unduplicated) With at Least One Service 164
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Center 53
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 64 70.228600 3843.9300 1569.5300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 72 72.250000 4538.1000 4538.1000
T 29 31.500000 1716.0400 1716.0400
667 707.150000 37390.2500 0.0000
Other 61 67.500000 3679.0000 0.0000
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Total 893 948.628600 51167.3200 7823.6700