CMS/EIP Fiscal Report Center: 07
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 1552 1870.250000 69199.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 54 58.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1504 3171.250000 117234.5000 36.9679
Subtotal (Total Children Is Unduplicated) 1809 5099.500000 186433.7500 36.5592
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 6.000000 87.4800 14.5800
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 9 9.000000 88.1100 9.7900
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 9 9.000000 242.3200 26.9244
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 37.0600 12.3533
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
EXIT-EXIT-EXIT ASSESSMENT 21 33.500000 1675.0000 50.0000
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 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 14.000000 777.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 8.000000 444.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 66 132.000000 9900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 30 60.000000 4500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 216.000000 11988.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 125 249.000000 13819.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 77 160.000000 12000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 86 178.000000 13350.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 384 1116.500000 71491.9600 64.0322
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EI Services,Class #03
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 1.000000 50.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 57 58.000000 2900.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 97 98.750000 4937.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 14 11.750000 293.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 186 247.000000 12350.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 159 261.750000 13087.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 111 135.500000 6775.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 85 101.750000 5087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 35 41.750000 2087.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 26 29.250000 1462.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 64 75.750000 3787.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 75 79.000000 3950.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 54 171.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 25 80.000000 4000.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 334 1442.500000 72082.0000 49.9702
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 80 192.750000 9637.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1208 6594.000000 66660.0000 10.1092
OCCT-97530-OT SESSION BY LICENSED OT 19 54.500000 3485.9800 63.9629
OCCT-97530GT-OT SESSION BY LICENSED OT 3 5.000000 357.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 22 89.000000 6324.0500 71.0567
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.250000 446.5000 71.4400
SENS-V5264-EARMOLD 1 1.000000 18.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 83 308.000000 20801.5800 67.5376
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 7.000000 457.5800 65.3686
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 3 5.500000 203.5000 37.0000
TRAV-TRAVS-Travel by mile 23 996.000000 443.0100 0.4448
Subtotal (Total Children Is Unduplicated) 1315 11097.50000 241773.1500 21.7863
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Total 17313.500000 499698.8600 28.8618
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Number of Children (Unduplicated) With at Least One Service 2225
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Center 07
Flag Claims Units Chgs Paid
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R 93 84.750000 3135.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 993 966.750000 45570.5000 0.0000
P 6080 12487.941940 310801.7555 310661.1500
D 17 17.750000 1073.7500 0.0000
S 1 0.250000 9.2500 0.0000
H 10 20.000000 1500.0000 0.0000
T 1 0.250000 9.2500 0.0000
6527 3578.808060 131676.6045 0.0000
Other 306 157.000000 5922.0000 0.0000
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Total 14028 17313.500000 499698.8600 310661.1500