CMS/EIP Fiscal Report Center: 53
Services beginning 07/01/2022 ending 09/30/2022 Date of Report:10/18/2022 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
CASE-CASE-NON-TCM CASE MANAGEMENT 970 1453.250000 53782.4500 37.0084
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 30 30.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 469 690.500000 25548.5000 37.0000
Subtotal (Total Children Is Unduplicated) 1083 2174.500000 79330.9500 36.4824
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 2.000000 97.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.5100 19.5100
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 22.0700 22.0700
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 28.9200 28.9200
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 8.000000 400.0000 50.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.500000 487.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 8 12.000000 900.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 16 29.500000 1637.2500 55.5000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 31 72.500000 4400.6400 60.6985
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.750000 187.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 10 6.750000 337.5000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 10 9.000000 450.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 134 108.750000 5425.0000 49.8851
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 20 21.500000 1075.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 85 54.250000 2712.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 2 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 34 44.750000 2237.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 160 71.250000 3550.0000 49.8246
CONPP-CONPP-CONSULT, PT, PHONE 6 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 22 22.750000 1137.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 158 85.750000 4287.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 5 4.000000 100.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 341 1009.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 44 170.000000 8500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 20 56.500000 2825.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 577 2326.000000 23260.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 27.500000 1965.3800 71.4684
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.000000 357.2000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 43.500000 3111.2800 71.5237
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 16.000000 1144.6000 71.5375
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 68 49.500000 1831.5000 37.0000
TRAV-TRAVS-Travel by mile 276 16051.00000 7123.0900 0.4438
Subtotal (Total Children Is Unduplicated) 666 20195.00000 71988.6200 3.5647
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Total 22442.000000 155720.2100 6.9388
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Number of Children (Unduplicated) With at Least One Service 1305
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Center 53
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 0 0.000000 0.0000 0.0000
D 88 47.000000 1824.5900 0.0000
S 301 160.250000 6074.2500 0.0000
H 1 0.250000 12.5000 0.0000
T 1423 11868.500000 19171.4900 19171.4900
8310 10312.750000 126667.1300 0.0000
Other 69 53.250000 1970.2500 0.0000
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Total 10192 22442.000000 155720.2100 19171.4900