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
Payclass Filters:GR
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 596 1629.500000 60245.2500 36.9716
Subtotal (Total Children Is Unduplicated) 1642 3757.000000 107614.5000 28.6437
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 41.6100 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 5.000000 45.4000 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 112.6200 22.5240
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 69 108.000000 5400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 58 114.000000 8550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 74 142.500000 7908.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 64 136.000000 10200.0000 75.0000
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
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 204 540.500000 33786.3300 62.5094
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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 301 1348.000000 67007.5700 49.7089
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 21 64.000000 4157.1600 64.9556
PHY-97110-PT SESSION BY LICENSED PT 14 88.250000 5970.8800 67.6587
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 333.500000 22621.6800 67.8311
TRAV-TRAVS-Travel by mile 17 861.000000 329.7800 0.3830
Subtotal (Total Children Is Unduplicated) 1225 9300.250000 176642.1700 18.9933
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Total 13597.750000 318043.0000 23.3894
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Number of Children (Unduplicated) With at Least One Service 1972
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Center 07
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 2700 9213.500000 181802.5000 181802.5000
D 179 143.250000 5982.2500 0.0000
S 1 60.000000 2220.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6507 4181.000000 128038.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 9387 13597.750000 318043.0000 181802.5000