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
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 2182 5291.500000 195683.7500 36.9808
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1627 2811.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 730 2909.750000 107595.5000 36.9776
Subtotal (Total Children Is Unduplicated) 2394 11012.50000 303279.2500 27.5395
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 9.000000 122.3100 13.5900
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 12 13.000000 115.5800 8.8908
AUDE-92568-ACOUSTIC REFLEX TESTING (MEMR) 4 4.000000 38.0400 9.5100
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 17 19.000000 516.1700 27.1668
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 84.8400 84.8400
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 10 10.000000 174.4000 17.4400
EXIT-EXIT-EXIT ASSESSMENT 22 23.250000 1162.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 32.000000 2400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 32.500000 2437.5000 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 4 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 24 29.000000 1609.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 5 8.000000 600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 67.500000 3746.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 41 69.500000 5212.5000 75.0000
SCREEN-T1023-SCREENING 4 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 154 356.250000 20875.3000 58.5973
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 497.7500 165.9167
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 400 356.250000 17812.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 31 12.500000 312.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 17 76.000000 5572.3200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1235 7585.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 40.750000 1018.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 160 1147.260400 57363.0200 50.0000
INTR-T1013-INTERPRETER 1 12.000000 770.0000 64.1667
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1481 27694.00000 276880.0000 9.9978
OCCT-97530-OT SESSION BY LICENSED OT 20 101.391096 7243.3800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 11 108.000000 7651.2000 70.8444
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.000000 41.6400 13.8800
TRAV-TRAVS-Travel by mile 1047 210287.0000 93579.1300 0.4450
Subtotal (Total Children Is Unduplicated) 1488 250637.9015 627446.2800 2.5034
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Total 262006.651496 951600.8300 3.6320
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Number of Children (Unduplicated) With at Least One Service 2449
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Center 53
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 3 1.750000 64.7500 0.0000
P 2 2.000000 60.0000 59.2500
D 36 40.500000 2057.4500 0.0000
S 0 0.000000 0.0000 0.0000
H 16124 122048.571096 199339.5700 199139.5700
T 10265 82595.000000 123127.8900 123127.8900
49249 57318.830400 626951.1700 50.0000
Other 0 0.000000 0.0000 0.0000
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Total 75679 262006.651496 951600.8300 322376.7100