CMS/EIP Fiscal Report Center: 52
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 275 133.250000 4911.7500 36.8612
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 186 125.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 680 1755.000000 64324.5000 36.6521
Subtotal (Total Children Is Unduplicated) 734 2013.250000 69236.2500 34.3903
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Screening, Eval, and Assessment,Class #02
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 70.4000 70.4000
EXIT-EXIT-EXIT ASSESSMENT 4 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 14.000000 1050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 14.000000 777.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 138 288.500000 20950.6700 72.6193
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 143.000000 10009.4800 69.9964
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 43.500000 3099.4900 71.2526
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 143 282.000000 15651.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 22.000000 1650.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 4.000000 153.1500 38.2875
SCREEN-T1023-SCREENING 26 26.000000 1300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 208 874.000000 56640.5900 64.8062
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 118 131.750000 6587.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 122 188.250000 9412.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 6 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 111 245.500000 12275.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 37.250000 1862.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.500000 37.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 76 93.000000 4650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 0.750000 18.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 78 111.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 353 2088.250000 103712.5000 49.6648
INTR-T1013-INTERPRETER 8 50.500000 2525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 631 4744.000000 47440.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 90 407.000000 28718.8800 70.5624
OCCT-97530HM-OT SESSION BY OT ASST 44 291.500000 16559.4000 56.8075
PHY-97110-PT SESSION BY LICENSED PT 74 404.750000 28033.0400 69.2601
PHY-97110HM-PT SESSION BY PT ASST 5 20.000000 1143.2000 57.1600
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 228 1255.250000 85907.8200 68.4388
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.750000 52.0500 13.8800
TRAV-TRAVS-Travel by mile 535 47161.00000 20983.0600 0.4449
Subtotal (Total Children Is Unduplicated) 693 57241.75000 370581.2000 6.4740
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Total 60129.000000 496458.0400 8.2565
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Number of Children (Unduplicated) With at Least One Service 844
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Center 52
Flag Claims Units Chgs Paid
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R 15 12.750000 743.3900 0.0000
U 0 0.000000 0.0000 0.0000
B 260 259.750000 12169.5800 0.0000
P 1785 1833.000000 85391.0700 82468.0000
D 0 0.000000 0.0000 0.0000
S 117 86.750000 2632.7500 75.0000
H 101 114.000000 7812.1000 0.0000
T 5925 53912.250000 189792.0400 178671.9300
2979 3910.500000 197917.1100 409.2600
Other 0 0.000000 0.0000 0.0000
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Total 11182 60129.000000 496458.0400 261624.1900