CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2017 ending 06/30/2018 Date of Report:08/10/2018 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 1848 4250.000000 157093.7500 36.9632
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1618 3755.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2116 10282.25000 379917.0000 36.9488
Subtotal (Total Children Is Unduplicated) 2284 18288.00000 537010.7500 29.3641
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 4 7.000000 339.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 51.3500 51.3500
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 37.8300 12.6100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 21.5500 21.5500
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 115.6400 8.2600
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 9 9.000000 81.5400 9.0600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 13 14.000000 354.3400 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 6 6.000000 111.3000 18.5500
EXIT-EXIT-EXIT ASSESSMENT 28 27.750000 1387.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 59 135.000000 10125.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 78 180.500000 13462.5000 74.5845
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 37 69.000000 5175.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 114 256.000000 14208.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 102 180.000000 13425.0000 74.5833
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 82 137.500000 10312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 34 56.500000 4237.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 592 1033.500195 57298.2609 55.4410
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 551 977.999970 73273.4978 74.9218
NURS-T1001-NURSING ASSESSMENT 1 1.000000 50.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 876 3119.250165 204732.4087 65.6351
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 11.000000 1464.0000 133.0909
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 200 227.750000 11387.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 8.750000 218.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 753 3354.000000 167556.2500 49.9571
CONIP-CONIP-CONSULT, ITDS PHONE 120 63.000000 1575.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 5 3.250000 162.5000 50.0000
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
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 23 62.000000 4545.8400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1015 6087.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 44 82.750000 2068.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1234 15789.25000 789462.0000 50.0000
INTR-T1013-INTERPRETER 5 22.250000 1337.5000 60.1124
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1385 26335.00000 263301.0000 9.9981
OCCT-97530-OT SESSION BY LICENSED OT 23 319.959991 22857.9414 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 5 19.000000 1086.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 5 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 128.000000 9144.3200 71.4400
TRAV-TRAVS-Travel by mile 977 202301.0000 90047.0600 0.4451
Subtotal (Total Children Is Unduplicated) 1388 254844.7100 1368130.8014 5.3685
-----------------------------------------------------------------------------------------------------------------------
Total 276251.960156 2109873.9601 7.6375
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2293
-----------------------------------------------------------------------------------------------------------------------
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 329 214.750000 8097.5000 0.0000
P 14154 13284.568900 600096.3027 588204.2800
D 5 7.000000 467.1900 0.0000
S 30 26.500000 1083.5000 0.0000
H 16101 121571.351483 209141.6000 209141.6000
T 9092 68617.726819 122397.9928 122388.0000
56705 72105.312954 1144081.2446 50.0000
Other 345 423.250000 24440.1300 0.0000
---------------------------------------------------------
Total 96763 276251.960156 2109873.9601 919783.8800