CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2018 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 2183 5294.250000 195785.5000 36.9808
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1628 2813.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2318 10366.00000 382876.0000 36.9358
Subtotal (Total Children Is Unduplicated) 2515 18474.00000 578661.5000 31.3230
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 2 3.000000 145.5000 48.5000
AUD-92626-EVAL OF AUD REHAB STATUS 1 1.000000 56.4900 56.4900
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.4200 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 8 12.000000 162.6600 13.5550
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 17 19.000000 169.2400 8.9074
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 7 7.000000 67.0200 9.5743
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 23 26.000000 682.8500 26.2635
AUDE-92585-AUD EVOKED RESPONSE (COMP) 2 2.000000 169.6800 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 13 13.000000 226.3500 17.4115
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 1.000000 115.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 23 24.250000 1212.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 55 124.500033 9337.5025 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 76 164.500000 12337.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 7.500000 562.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 35 71.500000 5362.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 97 209.500000 11646.7500 55.5931
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 145 252.500000 18937.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 97 160.000000 12000.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 93 142.500000 10650.0000 74.7368
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 623 1064.576304 58829.7350 55.2612
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 517 923.500000 69075.0000 74.7970
SCREEN-T1023-SCREENING 5 8.000000 400.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 941 3239.826337 212236.7475 65.5087
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 8.000000 3909.2700 488.6588
AUD-92592TS-AUDIOLOGY SERVICES (Monaural) 1 1.000000 50.0000 50.0000
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
AUDE-V5160-DISPENSING FEE BINAURAL 2 2.000000 460.0000 230.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 128 121.250000 6000.7500 49.4907
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 25 11.500000 287.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 725 2216.750000 110768.7500 49.9690
CONIP-CONIP-CONSULT, ITDS PHONE 88 34.750000 862.7500 24.8273
CONOF-CONOF-CONSULT, OT, FACE TO FACE 418 356.500000 17762.5000 49.8247
CONOP-CONOP-CONSULT, OT, PHONE 61 32.500000 812.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 433 411.250000 20500.0000 49.8480
CONPP-CONPP-CONSULT, PT, PHONE 2 2.500000 62.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 400 357.250000 17862.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 31 12.500000 312.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 20 97.000000 7112.0400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1235 7587.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 66 143.250000 3581.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1235 16023.74854 801523.4270 50.0210
INTR-T1013-INTERPRETER 1 12.000000 770.0000 64.1667
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1481 27697.00000 276910.0000 9.9978
OCCT-97530-OT SESSION BY LICENSED OT 100 900.500052 64060.8426 71.1392
OCCT-97530HM-OT SESSION BY OT ASST 13 35.000000 2002.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 88 713.250000 50858.2000 71.3049
PHY-97110HM-PT SESSION BY PT ASST 10 16.000000 914.5600 57.1600
SENS-V5264-EARMOLD 1 4.000000 72.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 93 716.000000 50968.0200 71.1844
SPL-92508-GROUP SPL SESSION PER CHILD 9 11.250000 156.1500 13.8800
TRAV-TRAVS-Travel by mile 1047 210321.0000 93594.2700 0.4450
Subtotal (Total Children Is Unduplicated) 1489 267846.9986 1532274.2796 5.7207
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Total 289560.824929 2323172.5271 8.0231
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Number of Children (Unduplicated) With at Least One Service 2538
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Center 53
Flag Claims Units Chgs Paid
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R 10 9.250000 428.9300 0.0000
U 0 0.000000 0.0000 0.0000
B 4403 3989.500000 182591.9700 218.8800
P 10828 10274.701546 476409.2051 477976.4000
D 231 232.079585 12898.6300 0.0000
S 155 147.500000 6806.2300 5419.2700
H 16790 122689.714981 237615.5042 235725.7000
T 10509 82844.350476 137343.1800 137333.9300
59962 68348.978341 1205711.9678 50.0000
Other 933 1024.750000 63366.9100 0.0000
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Total 103821 289560.824929 2323172.5271 856724.1800