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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 887 2890.000000 106856.0000 36.9744
Subtotal (Total Children Is Unduplicated) 887 2890.000000 106856.0000 36.9744
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Screening, Eval, and Assessment,Class #02
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-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 22.4000 22.4000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 21 39.500000 2962.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 31.000000 1720.5000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 28 98.000000 6343.6400 64.7310
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 13.000000 1111.1300 85.4715
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 109 742.000000 37100.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 247 1683.500000 84175.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 725 7648.000000 76480.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 25 77.250000 5518.7400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 11 38.250000 2732.5800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 6.750000 386.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 20 80.000000 5715.2000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 12.000000 857.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 175.750000 12424.6500 70.6950
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 45 209.500000 14966.6800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 31 41.000000 1517.0000 37.0000
Subtotal (Total Children Is Unduplicated) 1153 11671.75000 289053.1100 24.7652
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Total 14659.750000 402252.7500 27.4393
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Number of Children (Unduplicated) With at Least One Service 1659
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Center 10
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 3854 11633.750000 288094.4200 288094.4200
D 1 0.500000 18.5000 0.0000
S 36 48.000000 1306.8300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3771 2977.500000 112833.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 7662 14659.750000 402252.7500 288094.4200