CMS/EIP Fiscal Report Center: 07
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 1321 1280.250000 47369.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 738 847.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1633 4233.500000 156510.0000 36.9694
Subtotal (Total Children Is Unduplicated) 1848 6361.000000 203879.2500 32.0514
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.000000 83.2200 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 72.6400 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 8 9.000000 223.9400 24.8822
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 50.1000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 69 108.000000 5400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 135 265.500000 19912.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 157 304.500000 16899.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 152 319.500000 23962.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 363 1084.500000 70331.0800 64.8512
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EI Services,Class #03
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 70 70.250000 3512.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 78 171.250000 8562.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 3.000000 75.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 15.000000 750.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 14 17.000000 850.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 16 34.000000 1700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.250000 31.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 146 194.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 320 1408.000000 69979.2100 49.7011
INTR-T1013-INTERPRETER 1 6.000000 300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1124 6088.000000 60593.3500 9.9529
OCCT-97530-OT SESSION BY LICENSED OT 39 132.000000 9015.0800 68.2961
PHY-97110-PT SESSION BY LICENSED PT 21 135.000000 9310.7000 68.9681
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 112 500.250000 34534.3000 69.0341
TRAV-TRAVS-Travel by mile 17 861.000000 329.7800 0.3830
Subtotal (Total Children Is Unduplicated) 1227 9641.750000 199724.1700 20.7145
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Total 17087.250000 473934.5000 27.7361
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Number of Children (Unduplicated) With at Least One Service 2032
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Center 07
Flag Claims Units Chgs Paid
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R 13 9.500000 351.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 36.000000 1421.0000 0.0000
P 6381 12627.250000 334603.7500 334289.0000
D 179 143.250000 5982.2500 0.0000
S 9 68.000000 2620.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6538 4202.250000 128919.0000 0.0000
Other 2 1.000000 37.0000 0.0000
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Total 13162 17087.250000 473934.5000 334289.0000