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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1473 1511.750000 55916.2500 36.9878
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 748 739.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1641 4196.000000 154826.5000 36.8986
Subtotal (Total Children Is Unduplicated) 1922 6447.000000 210742.7500 32.6885
-----------------------------------------------------------------------------------------------------------------------
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 9 18.000000 1350.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 25.000000 1387.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 145 284.500000 21287.5000 74.8243
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 191 379.000000 21034.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 171 336.000000 25200.0000 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) 504 1343.500000 84915.0900 63.2044
-----------------------------------------------------------------------------------------------------------------------
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 198 227.250000 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 1283 7965.000000 79650.0000 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 13 843.000000 375.0500 0.4449
Subtotal (Total Children Is Unduplicated) 1362 12224.75000 251735.6700 20.5923
-----------------------------------------------------------------------------------------------------------------------
Total 20015.250000 547393.5100 27.3488
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2146
-----------------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 10.750000 397.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2111 1841.250000 78632.4500 129.5000
P 5382 13550.013300 318255.4000 318227.5800
D 19 18.500000 886.5000 0.0000
S 57 34.000000 1260.0000 0.0000
H 18 34.500000 2587.5000 0.0000
T 0 0.000000 0.0000 0.0000
7281 4526.236700 145373.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14878 20015.250000 547393.5100 318357.0800