CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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
TCM-T1017TL-TARGETED CASE MANAGEMENT 2741 8981.000000 332019.5000 36.9691
Subtotal (Total Children Is Unduplicated) 2741 8981.000000 332019.5000 36.9691
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 9 9.000000 175.6900 19.5211
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 9 9.000000 128.3800 14.2644
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.7000 23.7000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 85.2700 9.4744
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 10.000000 292.9600 29.2960
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 7 7.000000 150.7600 21.5371
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.500000 187.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 8 14.500000 804.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 52 108.000000 8100.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 277 551.000000 41325.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 24.500000 1837.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 108 219.500000 16462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 28.500000 2137.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 64 119.000000 8925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 119.000000 6604.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 234 454.500000 25224.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 32.000000 2361.0000 73.7813
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 163.000000 12225.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 18 18.000000 918.9000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 5.000000 204.2000 40.8400
Subtotal (Total Children Is Unduplicated) 511 1985.500000 133179.5100 67.0761
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 11 31.000000 8822.3400 284.5916
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 33 36.500000 1825.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 179 179.500000 8975.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 31.000000 775.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 62 88.500000 4425.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 171 241.250000 12062.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 10.750000 268.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 27 41.000000 2050.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 2.000000 50.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 7 7.000000 350.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 75 94.250000 4712.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 17 20.000000 1000.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 157 186.000000 9300.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 534 4579.500000 228926.0000 49.9893
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 770 5430.500000 271525.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 725 7648.000000 76480.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 248 1100.000000 76313.1600 69.3756
OCCT-97530GT-OT SESSION BY LICENSED OT 75 343.750000 24418.8000 71.0365
OCCT-97530HM-OT SESSION BY OT ASST 36 191.000000 10526.5200 55.1127
OCCT-97530HMGT-OT SESSION BY OT ASST 4 18.750000 1072.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 347 1650.500000 116889.5300 70.8207
PHY-97110GT-PT SESSION BY LICENSED PT 104 361.500000 25137.5000 69.5367
SENS-V5264-EARMOLD 3 7.000000 126.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 368 1724.750000 121972.0900 70.7187
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 200 1043.750000 74309.0000 71.1943
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.500000 250.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.500000 34.7000 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 31 41.000000 1517.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1728 25123.75000 1084503.3300 43.1665
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Total 36090.250000 1549702.3400 42.9396
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Number of Children (Unduplicated) With at Least One Service 3051
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Center 10
Flag Claims Units Chgs Paid
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R 285 206.000000 7980.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1475 1144.500000 44993.5000 0.0000
P 12081 19822.750000 687803.6900 689815.5800
D 76 93.000000 5637.0000 0.0000
S 153 256.500000 14802.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7870 14567.500000 788485.3900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 21940 36090.250000 1549702.3400 689815.5800