CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 1881 5004.500000 185166.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 591 604.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1951 7349.750000 271894.5000 36.9937
Subtotal (Total Children Is Unduplicated) 2153 12959.00000 457061.0000 35.2698
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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 118 237.000000 11850.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 23.500000 1762.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.500000 487.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 27.000000 1498.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 189 321.500000 23895.0000 74.3235
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 220.000000 16400.0000 74.5455
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 120 204.500000 15312.7000 74.8787
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 248 438.000000 24153.5000 55.1450
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 121 205.000000 15007.0000 73.2049
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 16 63.000000 3150.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 554 1802.500000 117361.1000 65.1102
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 163 286.750000 14325.0000 49.9564
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 3 5.500000 275.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 80 86.750000 2168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 16 22.000000 1075.0000 48.8636
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 2.000000 100.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 6 6.000000 300.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 18 22.000000 1100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 24 33.000000 1650.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1 2.000000 100.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 191 247.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1299 9160.000000 457900.0000 49.9891
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 219 280.000000 14000.0000 50.0000
INTR-T1013-INTERPRETER 103 212.750000 10637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 91 619.000000 6190.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 162 1061.000000 74631.3200 70.3405
OCCT-97530GT-OT SESSION BY LICENSED OT 30 45.000000 3214.8000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 198 1489.250000 105954.3200 71.1461
PHY-97110GT-PT SESSION BY LICENSED PT 16 41.000000 2929.0400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 3.000000 214.3200 71.4400
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 513 4201.000000 298083.6300 70.9554
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 88 169.500000 12109.0800 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
TRAV-TRAVS-Travel by mile 1664 158852.0000 69272.1100 0.4361
Subtotal (Total Children Is Unduplicated) 1849 176858.7500 1077027.8300 6.0898
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Total 191620.250000 1651449.9300 8.6183
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Number of Children (Unduplicated) With at Least One Service 2380
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Center 09
Flag Claims Units Chgs Paid
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R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 176 171.250000 6781.2500 0.0000
P 23619 178189.000000 1107254.9100 1107304.1700
D 58 53.500000 2186.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 343 512.500000 25462.0000 0.0000
T 0 0.000000 0.0000 0.0000
3065 12415.000000 489187.3800 0.0000
Other 162 277.000000 20428.2500 0.0000
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Total 27424 191620.250000 1651449.9300 1107304.1700