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: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 2078 4617.000000 170672.7500 36.9662
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1894 4288.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2406 11714.00000 432891.7500 36.9551
Subtotal (Total Children Is Unduplicated) 2578 20619.75000 603564.5000 29.2712
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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 29 28.750000 1437.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 60 136.500000 10237.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 80 184.000000 13725.0000 74.5924
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 45 82.500000 6225.0000 75.4545
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 122 270.500000 15012.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 232.500000 17362.5000 74.6774
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 104 171.500000 12862.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 68.000000 5100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 806 1371.000195 76029.5109 55.4555
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 752 1317.499970 98735.9978 74.9419
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) 1137 3928.250165 258555.9087 65.8196
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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 201 228.250000 11412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 13 8.750000 218.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 758 3372.250000 168468.7500 49.9574
CONIP-CONIP-CONSULT, ITDS PHONE 121 63.500000 1587.5000 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 1204 6333.000000 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 1242 15849.25000 792462.0000 50.0000
INTR-T1013-INTERPRETER 5 22.250000 1337.5000 60.1124
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1650 26947.00000 269421.0000 9.9982
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 1082 205202.0000 91338.3300 0.4451
Subtotal (Total Children Is Unduplicated) 1654 258682.4600 1379492.0714 5.3328
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Total 283230.460156 2241612.4801 7.9144
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Number of Children (Unduplicated) With at Least One Service 2588
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Center 53
Flag Claims Units Chgs Paid
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R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 368 246.000000 9310.7500 9.2500
P 15452 14685.837820 665962.5528 653421.0300
D 5 7.000000 467.1900 0.0000
S 32 28.750000 1166.7500 0.0000
H 16288 123331.601483 211442.0900 211442.0900
T 9226 69802.476819 125093.8028 125083.8100
59463 74673.044034 1201541.9645 50.0000
Other 364 454.250000 26558.8800 0.0000
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Total 101200 283230.460156 2241612.4801 990006.1800