CMS/EIP Fiscal Report Center: 53
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 836 1122.500000 41532.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 562 644.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 934 2512.500000 92768.7500 36.9229
Subtotal (Total Children Is Unduplicated) 1093 4279.000000 134301.2500 31.3861
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 8 8.250000 412.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 45.000000 3375.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 28 60.000000 4500.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1275.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 70.000000 3912.7500 55.8964
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 59.000000 4425.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 45.000000 3375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 19 29.500000 2212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 168 287.500000 15900.7500 55.3070
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 138 241.500000 18075.0000 74.8447
Subtotal (Total Children Is Unduplicated) 271 873.250000 57870.8600 66.2707
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 49.4300 49.4300
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 27 20.750000 1037.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 276 541.750000 27087.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 23 7.500000 181.5000 24.2000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 166 104.000000 5187.5000 49.8798
CONOP-CONOP-CONSULT, OT, PHONE 18 7.250000 181.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 143 93.250000 4650.0000 49.8660
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 81 54.500000 2725.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 2.000000 50.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 22.000000 1613.0400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 604 1854.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 25 39.000000 975.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 763 4106.000000 205300.0000 50.0000
INTR-T1013-INTERPRETER 1 2.000000 140.0000 70.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 882 6452.000000 64500.0000 9.9969
OCCT-97530-OT SESSION BY LICENSED OT 16 54.499992 3893.4792 71.4400
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 24.000000 1714.5600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 534 45433.00000 20223.2700 0.4451
Subtotal (Total Children Is Unduplicated) 883 58824.24999 339608.9092 5.7733
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Total 63976.499992 531781.0192 8.3121
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Number of Children (Unduplicated) With at Least One Service 1204
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Center 53
Flag Claims Units Chgs Paid
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R 21 18.500000 739.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 773 715.500000 29755.7500 2.0000
P 2700 2714.320600 127242.2800 127349.4200
D 1 1.000000 73.3200 0.0000
S 17 17.750000 720.5000 0.0000
H 2254 15655.287512 28278.1100 28278.1100
T 3440 28802.500000 40652.7700 40652.7700
14489 15823.141880 291592.8192 0.0000
Other 201 228.500000 12725.9700 0.0000
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Total 23896 63976.499992 531781.0192 196282.3000