CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Payclass Filters:GR
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 779 638.000000 23606.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 280 333.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 251 332.000000 12284.0000 37.0000
Subtotal (Total Children Is Unduplicated) 828 1303.500000 35890.0000 27.5336
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
EXIT-EXIT-EXIT ASSESSMENT 36 49.250000 2462.5000 50.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 18 32.500000 2437.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 27 50.000000 3750.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 92.000000 5106.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 103 248.750000 15292.7400 61.4784
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 5.000000 676.4700 135.2940
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 53 70.000000 3500.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 61 52.000000 2600.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 21 22.750000 1137.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 40 33.000000 1650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 134 743.500000 37175.0000 50.0000
INTR-T1013-INTERPRETER 24 85.000000 4250.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 515 3141.000000 31410.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 53.500000 3822.0400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 56.500000 4036.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 50.750000 3625.5800 71.4400
TRAV-TRAVS-Travel by mile 334 23171.00000 10308.7900 0.4449
Subtotal (Total Children Is Unduplicated) 709 27486.50000 104279.2400 3.7938
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Total 29038.750000 155461.9800 5.3536
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Number of Children (Unduplicated) With at Least One Service 1078
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Center 02
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4559 13439.750000 91373.0600 91336.9100
37 33.500000 568.6000 0.0000
Other 3679 15565.500000 63520.3200 0.0000
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Total 8275 29038.750000 155461.9800 91336.9100