CMS/EIP Fiscal Report Center: 53
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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
CASE-CASE-NON-TCM CASE MANAGEMENT 993 1710.500000 63205.5000 36.9515
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 18 13.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1243 3209.750000 118696.0000 36.9798
Subtotal (Total Children Is Unduplicated) 1327 4934.000000 181901.5000 36.8669
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.4200 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 3 3.000000 27.2400 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 6.000000 166.9800 27.8300
AUDE-92582-CONDITIONED PLAY AUDIOMETRY 1 1.000000 38.4700 38.4700
EVAL-96111-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 22 43.000000 2150.0000 50.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.500000 112.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 23.000000 1725.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 36.000000 1998.0000 55.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 87 166.000000 12450.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 22.000000 1650.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 88 164.500000 12337.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 62 115.000000 8625.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 172 368.000000 20424.0000 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 113.000000 8475.0000 75.0000
Subtotal (Total Children Is Unduplicated) 248 1122.000000 74300.7300 66.2217
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 7 3.750000 187.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 22 15.500000 775.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 15 6.250000 312.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 216 247.250000 12338.0000 49.9009
CONOF-CONOF-CONSULT, OT, FACE TO FACE 8 5.750000 287.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 168 127.000000 6350.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 6 5.000000 250.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 127 65.000000 3250.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 21 15.750000 762.5000 48.4127
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 127 108.750000 5437.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 1.500000 37.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 12 26.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 24 41.500000 2075.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 488 2488.250000 124412.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 10 16.000000 160.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 7.000000 500.0800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 53 223.250000 15927.5400 71.3440
OCCT-97530TL-OT SESSION BY LICENSED OT 3 8.000000 571.5200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 32 124.000000 8858.5600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 7.750000 553.6600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 27 153.250000 10948.1800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 22 126.750000 9055.0200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 6.000000 428.6400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 40 142.250000 10162.3400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 40 214.000000 15266.7200 71.3398
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 33 50.500000 1868.5000 37.0000
TRAV-TRAVS-Travel by mile 5 66.000000 29.3500 0.4447
Subtotal (Total Children Is Unduplicated) 707 4304.250000 230902.0500 53.6451
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Total 10360.250000 487104.2800 47.0167
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Number of Children (Unduplicated) With at Least One Service 1402
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Center 53
Flag Claims Units Chgs Paid
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R 49 49.250000 1960.0100 0.0000
U 0 0.000000 0.0000 0.0000
B 2648 2398.750000 115675.9900 0.0000
P 2111 1860.250000 88710.3500 88710.3500
D 253 197.500000 10146.8600 0.0000
S 87 65.000000 2880.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 85 84.000000 4211.0000 4136.0000
8037 5666.000000 261129.0800 0.0000
Other 42 39.500000 2390.2300 92.5000
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Total 13312 10360.250000 487104.2800 92938.8500