CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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 74 103.000000 3811.0000 37.0000
Subtotal (Total Children Is Unduplicated) 74 103.000000 3811.0000 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 186.5000 62.1667
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 57 86.500000 6487.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 19 29.500000 2212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 15.000000 1125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 25.500000 1415.2500 55.5000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 48.5000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 20 20.000000 970.0000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 13 13.000000 630.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 24 24.000000 1164.0000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 24 24.000000 1164.0000 48.5000
Subtotal (Total Children Is Unduplicated) 162 243.000000 15516.2500 63.8529
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2407 20720.25000 1035692.5000 49.9846
OCCT-97530-OT SESSION BY LICENSED OT 238 1596.750000 108387.3900 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 14 81.000000 4399.9200 54.3200
PHY-97110-PT SESSION BY LICENSED PT 267 1551.000000 105281.8800 67.8800
PHY-97110HM-PT SESSION BY PT ASST 35 196.250000 10660.3000 54.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 276 1735.000000 117771.8000 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 35.500000 1928.3600 54.3200
Subtotal (Total Children Is Unduplicated) 2827 25920.75000 1384247.1500 53.4031
-----------------------------------------------------------------------------------------------------------------------
Total 26266.750000 1403574.4000 53.4354
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2970
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 95 71.000000 2627.0000 0.0000
P 51 34.750000 1324.7500 1324.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2443 8141.250000 413609.8000 297069.7200
T 0 0.000000 0.0000 0.0000
226 447.500000 29785.9600 0.0000
Other 1 3.500000 237.5800 237.5800
---------------------------------------------------------
Total 2816 8698.000000 447585.0900 298632.0500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 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
1691 5166.000000 285615.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1691 5166.000000 285615.8400 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 1 4.000000 200.0000 40.0000
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
2090 6304.000000 337504.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2091 6308.000000 337704.4000 40.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 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
106 161.000000 11539.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 106 161.000000 11539.2500 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 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
1743 5933.750000 321129.8200 321129.8200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1743 5933.750000 321129.8200 321129.8200