CMS/EIP Fiscal Report Center: 53
Services beginning 04/01/2019 ending 06/30/2019 Date of Report:07/21/2019 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 960 1535.000000 56776.5000 36.9879
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 628 680.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1084 2621.250000 96773.5000 36.9188
Subtotal (Total Children Is Unduplicated) 1239 4836.750000 153550.0000 31.7465
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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) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 55.6600 27.8300
EXIT-EXIT-EXIT ASSESSMENT 8 7.500000 375.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 16.000000 1200.0000 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 7 14.000000 1050.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 28.000000 1554.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 44 75.500000 5662.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 30 48.500000 3637.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 46.000000 3412.5000 74.1848
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 148 249.500000 13731.7500 55.0371
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 118 208.500000 15562.5000 74.6403
SCREEN-T1023-SCREENING 5 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 237 719.000000 47622.6200 66.2345
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 2195.9000 731.9667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 39 33.000000 1613.2500 48.8864
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 1.250000 31.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 269 481.500000 24050.0000 49.9481
CONIP-CONIP-CONSULT, ITDS PHONE 23 8.250000 206.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 122 91.500000 4550.0000 49.7268
CONOP-CONOP-CONSULT, OT, PHONE 4 1.250000 31.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 136 85.500000 4275.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 99.000000 4950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 11 6.000000 150.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 575 1865.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 23 42.000000 1050.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 589 3325.000000 166250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 851 6392.000000 63910.0000 9.9984
OCCT-97530-OT SESSION BY LICENSED OT 71 300.250000 21335.6200 71.0595
OCCT-97530HM-OT SESSION BY OT ASST 12 31.000000 1773.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 74 425.250000 30365.5800 71.4064
PHY-97110HM-PT SESSION BY PT ASST 4 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 385.250000 27461.1200 71.2813
SPL-92508-GROUP SPL SESSION PER CHILD 4 4.250000 58.9900 13.8800
TRAV-TRAVS-Travel by mile 530 45721.00000 20339.4200 0.4449
Subtotal (Total Children Is Unduplicated) 863 59305.50000 374825.4700 6.3202
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Total 64861.250000 575998.0900 8.8805
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Number of Children (Unduplicated) With at Least One Service 1350
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Center 53
Flag Claims Units Chgs Paid
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R 9 8.250000 378.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 2709 2458.500000 116191.8400 18.5000
P 1087 1008.000000 48207.1000 48095.0500
D 45 41.750000 2386.4000 0.0000
S 40 40.000000 1697.4600 1411.7000
H 3978 27505.500000 52457.2700 51338.9900
T 9 5.250000 85.5000 76.2500
17019 33408.750000 329814.9900 0.0000
Other 357 385.250000 24778.6000 0.0000
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Total 25253 64861.250000 575998.0900 100940.4900