CMS/EIP Fiscal Report Center: 54
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 811 577.000000 21349.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 716 745.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1522 4856.750000 179413.0000 36.9410
Subtotal (Total Children Is Unduplicated) 1568 6179.000000 200762.0000 32.4910
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 18.000000 873.0000 48.5000
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 55.6600 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 31 43.750000 2187.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 18 31.500000 2362.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 14.500000 1087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 131 216.500000 16200.0000 74.8268
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 62 93.000000 6975.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 30 45.000000 3375.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 160 256.000000 14208.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 124.500000 9337.5000 75.0000
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
Subtotal (Total Children Is Unduplicated) 333 923.750000 61285.8900 66.3447
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 19.000000 2732.8500 143.8342
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 104 123.500000 6146.4400 49.7687
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 483 558.250000 27887.5000 49.9552
CONIP-CONIP-CONSULT, ITDS PHONE 20 5.500000 137.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 332 151.250000 7550.0000 49.9174
CONOP-CONOP-CONSULT, OT, PHONE 4 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 214 110.750000 5525.0000 49.8871
CONPP-CONPP-CONSULT, PT, PHONE 4 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 160 121.000000 6050.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 4.000000 100.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 763 2200.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 661 3591.000000 179512.5000 49.9896
INTR-T1013-INTERPRETER 28 117.000000 2925.0000 25.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1102 8812.000000 88100.0000 9.9977
OCCT-97530-OT SESSION BY LICENSED OT 118 592.000000 42278.2400 71.4159
PHY-97110-PT SESSION BY LICENSED PT 112 581.750000 41613.8000 71.5321
PHY-97110HM-PT SESSION BY PT ASST 5 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 120 669.250000 47811.2200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 4.000000 55.5200 13.8800
TRAV-TRAVS-Travel by mile 758 54543.00000 24263.0800 0.4448
Subtotal (Total Children Is Unduplicated) 1107 72214.25000 483208.5900 6.6913
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Total 79317.000000 745256.4800 9.3959
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Number of Children (Unduplicated) With at Least One Service 1596
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Center 54
Flag Claims Units Chgs Paid
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R 106 99.250000 4119.9700 0.0000
U 0 0.000000 0.0000 0.0000
B 2939 2487.000000 119424.4300 108.4400
P 2915 2402.830000 106975.4500 106330.1300
D 104 101.750000 6818.0700 0.0000
S 2 2.000000 10.0000 0.0000
H 38 37.000000 2621.8400 37.0000
T 6316 34509.550000 79666.9400 79666.9400
21395 39527.370000 416698.0700 0.0000
Other 169 150.250000 8921.7100 27.7500
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Total 33984 79317.000000 745256.4800 186170.2600