CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2013 ending 03/31/2013 Date of Report:05/17/2013 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 5897 17701.50000 654428.2500 36.9702
Subtotal (Total Children Is Unduplicated) 5897 17701.50000 654428.2500 36.9702
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 51 89.000000 6675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 25.500000 1912.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 24.000000 1800.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 31 58.000000 4350.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 71 111.000000 6160.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 483 744.500000 55837.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 221 349.500000 26212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 209 297.500000 22312.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 882 1390.000000 77145.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 282 376.000000 28200.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 46 46.000000 2328.9800 50.6300
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 227.9200 32.5600
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 1223 3519.000000 233210.9000 66.2719
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 38 139.500000 6975.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 4 12.250000 831.5300 67.8800
PHY-97110-PT SESSION BY LICENSED PT 26 153.750000 10436.5500 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 151.000000 10249.8800 67.8800
Subtotal (Total Children Is Unduplicated) 102 456.500000 28492.9600 62.4161
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Total 21677.000000 916132.1100 42.2629
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Number of Children (Unduplicated) With at Least One Service 6038
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Center 02
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1097 717.000000 26186.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1099 717.500000 26205.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.500000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 484 415.750000 18471.0000 50.0000
P 1776 1125.750000 46223.7500 46249.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2267 1546.000000 64861.2500 46299.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 124 71.750000 2654.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2004 2094.250000 80461.0000 0.0000
P 1537 1907.250000 74005.9000 73963.7600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3665 4073.250000 157121.6500 73963.7600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 175.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 5471 5641.500000 251646.0800 0.0000
P 317 347.000000 17040.0000 17040.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5793 5993.250000 268861.8300 17040.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 344 196.750000 7279.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2720 1718.750000 63593.7500 0.0000
P 4250 3508.000000 166487.6300 166119.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7314 5423.500000 237361.1300 166119.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 2.500000 92.5000 0.0000
P 2222 2117.750000 82483.7500 82483.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2226 2120.250000 82576.2500 82483.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 183 160.250000 5929.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1195 1114.250000 44276.7500 0.0000
P 443 528.750000 28938.7500 28825.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1821 1803.250000 79144.7500 28825.3000