CMS/EIP Fiscal Report Center: 07
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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 1418 1449.000000 53594.5000 36.9872
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 714 707.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1578 3982.500000 146954.7500 36.9001
Subtotal (Total Children Is Unduplicated) 1857 6139.250000 200549.2500 32.6667
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 7 7.000000 97.0900 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 8 8.000000 72.6400 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 166.9800 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 50.1000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 22.4000 22.4000
EXIT-EXIT-EXIT ASSESSMENT 143 226.000000 11287.5000 49.9447
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 19.000000 1425.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 133 262.000000 19600.0000 74.8092
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 160 318.000000 17649.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 147 289.500000 21712.5000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 15 18.000000 827.5800 45.9767
Subtotal (Total Children Is Unduplicated) 458 1205.500000 75832.5900 62.9055
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.000000 2778.8700 1389.4350
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 82.000000 4100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 119 248.000000 12400.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 5 5.000000 125.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 13 27.000000 1350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 23 38.750000 1937.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 43 63.500000 3175.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 187 211.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 377 2063.250000 102101.9200 49.4860
INTR-T1013-INTERPRETER 3 30.000000 2620.0000 87.3333
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1264 7935.000000 79350.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 99.500000 6413.2800 64.4551
PHY-97110-PT SESSION BY LICENSED PT 12 80.000000 4806.0400 60.0755
PHY-97110HM-PT SESSION BY PT ASST 1 3.500000 4.9400 1.4114
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 94 442.000000 29773.0700 67.3599
TRAV-TRAVS-Travel by mile 12 817.000000 363.4800 0.4449
Subtotal (Total Children Is Unduplicated) 1335 12153.00000 251424.1000 20.6882
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Total 19497.750000 527805.9400 27.0701
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Number of Children (Unduplicated) With at Least One Service 2079
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Center 07
Flag Claims Units Chgs Paid
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R 9 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2035 1740.250000 73773.7000 129.5000
P 5284 13397.713300 313212.5800 313184.7600
D 13 10.000000 459.0000 0.0000
S 53 29.500000 1121.2500 0.0000
H 17 32.500000 2437.5000 0.0000
T 0 0.000000 0.0000 0.0000
6964 4278.036700 136441.1600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 14375 19497.750000 527805.9400 313314.2600