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:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1984 5197.500000 192307.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 661 651.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 2124 7793.250000 288304.0000 36.9941
Subtotal (Total Children Is Unduplicated) 2334 13642.25000 480611.5000 35.2296
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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 19 31.000000 2325.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 19.500000 1462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.000000 825.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 23 38.000000 2109.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 263 432.000000 32132.5000 74.3808
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 175 297.000000 22175.0000 74.6633
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 177 297.500000 22287.7000 74.9166
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 368 634.500000 35059.2500 55.2549
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 9 15.500000 860.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 156 256.000000 18832.0000 73.5625
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) 732 2376.000000 156121.3500 65.7076
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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 198 252.250000 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 110 220.500000 11025.0000 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 1672 159087.0000 69375.4800 0.4361
Subtotal (Total Children Is Unduplicated) 1871 177106.5000 1077518.7000 6.0840
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Total 193124.750000 1714251.5500 8.8764
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Number of Children (Unduplicated) With at Least One Service 2571
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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 183 179.750000 7152.7500 0.0000
P 24295 179313.000000 1148839.7800 1148943.1400
D 58 53.500000 2186.1400 0.0000
S 0 0.000000 0.0000 0.0000
H 550 786.500000 39152.2500 0.0000
T 0 0.000000 0.0000 0.0000
3072 12426.000000 489973.3800 0.0000
Other 217 364.000000 26797.2500 0.0000
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Total 28376 193124.750000 1714251.5500 1148943.1400