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
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 772 1021.500000 37786.2500 36.9909
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 652 742.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1032 2980.750000 110250.7500 36.9876
Subtotal (Total Children Is Unduplicated) 1123 4744.250000 148037.0000 31.2035
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 25.2200 12.6100
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 24.7800 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 3 3.000000 27.1800 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 3 3.000000 75.9300 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 37.1000 18.5500
EXIT-EXIT-EXIT ASSESSMENT 9 9.000000 450.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 41.000000 3075.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 44.000000 3225.0000 73.2955
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 19.000000 1425.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 53.500000 2969.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 35 62.000000 4650.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 34 56.500000 4237.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 17.500000 1312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 178 318.000000 17593.5000 55.3255
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 179 328.000000 24561.0000 74.8811
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 295 964.500000 63890.0100 66.2416
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 41 39.000000 1950.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 3 2.000000 50.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 294 863.750000 43143.7500 49.9493
CONIP-CONIP-CONSULT, ITDS PHONE 47 23.250000 581.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 2 0.500000 25.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.750000 18.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 556 1717.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 620 3551.750000 177600.0000 50.0035
INTR-T1013-INTERPRETER 1 4.000000 140.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 805 6199.000000 61980.0000 9.9984
OCCT-97530-OT SESSION BY LICENSED OT 19 101.000000 7215.4400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 1 6.000000 343.2000 57.2000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 42.000000 3000.4800 71.4400
TRAV-TRAVS-Travel by mile 479 43818.00000 19504.3200 0.4451
Subtotal (Total Children Is Unduplicated) 811 56379.00000 315911.3300 5.6034
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Total 62087.750000 527838.3400 8.5015
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Number of Children (Unduplicated) With at Least One Service 1209
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Center 53
Flag Claims Units Chgs Paid
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R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 348 233.000000 8621.0000 0.0000
P 3377 3259.978600 147984.6800 145597.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4037 29329.750000 51598.8000 51598.8000
T 2099 15743.750000 28860.6200 28860.6200
13904 13448.521400 286899.9900 0.0000
Other 65 70.750000 3799.2500 0.0000
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Total 23832 62087.750000 527838.3400 226057.2000