CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 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 788 1180.250000 43650.7500 36.9843
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 528 585.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 930 2346.750000 86690.5000 36.9407
Subtotal (Total Children Is Unduplicated) 1072 4112.000000 130341.2500 31.6978
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 2 2.000000 27.7400 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 27.2400 9.0800
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 1 1.000000 9.9600 9.9600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 139.1500 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 5 6.500000 325.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 24.000000 1800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 22.000000 1650.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 40.500000 2239.5000 55.2963
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 64.000000 4800.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 41.500000 3112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 34.000000 2550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 129 225.999999 12515.2500 55.3772
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 105 194.000000 14475.0000 74.6134
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 211 683.499999 44974.4500 65.8002
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 331.9200 331.9200
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 36 30.000000 1500.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 8 3.750000 93.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 250 468.500000 23418.7500 49.9867
CONIP-CONIP-CONSULT, ITDS PHONE 21 9.750000 243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 111 63.000000 3137.5000 49.8016
CONOP-CONOP-CONSULT, OT, PHONE 29 17.750000 443.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 173 131.500000 6425.0000 48.8593
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 177 136.000000 6800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 12 3.500000 87.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 26.000000 1906.3200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 564 1774.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 18 34.000000 850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 606 2816.750000 140748.5000 49.9684
INTR-T1013-INTERPRETER 1 2.000000 70.0000 35.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 830 5698.000000 56940.0000 9.9930
OCCT-97530-OT SESSION BY LICENSED OT 59 297.500000 20897.4000 70.2434
OCCT-97530HM-OT SESSION BY OT ASST 5 6.000000 343.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 58 273.000000 19435.3000 71.1916
PHY-97110HM-PT SESSION BY PT ASST 14 28.000000 1600.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 58 237.250000 16602.7600 69.9800
SPL-92508-GROUP SPL SESSION PER CHILD 7 11.000000 152.6800 13.8800
TRAV-TRAVS-Travel by mile 467 41723.00000 18563.8300 0.4449
Subtotal (Total Children Is Unduplicated) 832 53793.00000 320642.3900 5.9607
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Total 58588.499999 495958.0900 8.4651
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Number of Children (Unduplicated) With at Least One Service 1239
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Center 53
Flag Claims Units Chgs Paid
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R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1234 1166.000000 54255.2400 118.5000
P 1649 1506.028672 69328.8600 68824.0000
D 47 48.585585 2507.0200 0.0000
S 55 46.000000 1655.7500 1563.2500
H 648 4091.000000 8349.1200 8241.9600
T 1849 13777.000000 23900.7700 23900.7700
16158 37893.135742 332570.9300 0.0000
Other 46 52.500000 3009.1500 0.0000
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Total 21693 58588.499999 495958.0900 102648.4800