CMS/EIP Fiscal Report Center: 09
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 1825 4315.250000 159664.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 737 684.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2073 7672.250000 283873.2500 37.0000
Subtotal (Total Children Is Unduplicated) 2274 12671.50000 443537.5000 35.0028
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EXIT-EXIT-EXIT ASSESSMENT 123 244.000000 12200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 25.000000 1830.0000 73.2000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 23.000000 1675.0000 72.8261
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 26.500000 1987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 34.500000 1914.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 211 331.000000 24405.0000 73.7311
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 124 217.500000 16197.5000 74.4713
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 155 261.000000 19390.0000 74.2912
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 291 503.500000 27581.8000 54.7801
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 159 255.000000 18410.5000 72.1980
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 5 49.000000 2450.0000 50.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 189.2000 47.3000
Subtotal (Total Children Is Unduplicated) 626 2009.000000 130633.3500 65.0241
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 173 308.250000 15412.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 59 52.000000 1300.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 27 38.500000 1925.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 15 15.500000 775.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 25 29.000000 1450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 32 40.000000 2000.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 3.000000 75.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 246 329.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1317 9216.750000 460337.5000 49.9458
INTR-T1013-INTERPRETER 85 199.500000 9975.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 90 613.000000 6130.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 124 805.500000 55980.4300 69.4977
PHY-97110-PT SESSION BY LICENSED PT 220 1654.000000 117019.6100 70.7495
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 518 4384.750000 308563.0000 70.3719
TRAV-TRAVS-Travel by mile 1657 162110.0000 70841.3300 0.4370
Subtotal (Total Children Is Unduplicated) 1859 179805.5000 1052345.1200 5.8527
-----------------------------------------------------------------------------------------------------------------------
Total 194486.000000 1626515.9700 8.3632
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2454
-----------------------------------------------------------------------------------------------------------------------
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 357.000000 14796.2500 0.0000
P 22813 181935.000000 1076398.5000 1080180.1800
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 216 319.250000 15884.2500 0.0000
T 4 7.000000 404.4400 505.6900
2944 11516.250000 493394.5200 0.0000
Other 205 346.000000 25296.7500 0.0000
---------------------------------------------------------
Total 26520 194486.000000 1626515.9700 1080685.8700