CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2015 ending 12/31/2015 Date of Report:02/13/2016 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 10027 13273.75000 490413.7500 36.9461
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 6732 13419.50000 1082.2500 0.0806
TCM-T1017TL-TARGETED CASE MANAGEMENT 5963 16746.50000 613457.7500 36.6320
Subtotal (Total Children Is Unduplicated) 14927 43439.75000 1104953.7500 25.4365
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 23 27.000000 1309.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 87 108.000000 5375.0000 49.7685
EXIT-EXIT-EXIT ASSESSMENT 376 593.000000 29400.0000 49.5784
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 32.000000 2400.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 6.500000 487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 35.000000 1942.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 272 360.000000 26253.9900 72.9278
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 69 103.500000 7596.8900 73.3999
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 104.000000 7691.2500 73.9543
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 471 691.000000 38181.5000 55.2554
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 198 287.000000 21525.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 42 42.000000 1701.0000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 171.8100 57.2700
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 2 2.000000 113.2800 56.6400
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 199.2600 22.1400
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 102.1000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 15.000000 765.7500 51.0500
Subtotal (Total Children Is Unduplicated) 1261 2445.000000 146942.3800 60.0991
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 317 276.250000 13800.0000 49.9548
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 7.000000 175.0000 25.0000
CONIF-CONIF-CONSULT, FACE TO FACE 968 1487.000000 74206.2500 49.9033
CONIP-CONIP-CONSULT, PHONE 43 42.500000 1059.5000 24.9294
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 11.000000 806.5200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 21.000000 525.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 158 609.250000 30360.0000 49.8318
INTR-T1013-INTERPRETER 91 183.250000 9062.5000 49.4543
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1467 6729.000000 67202.0000 9.9869
OCCT-97530-OT SESSION BY LICENSED OT 6 14.000000 1000.1600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 12 32.500000 2181.1900 67.1135
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 36 100.500000 7025.7200 69.9077
TRAV-TRAVS-Travel by mile 524 28198.00000 12542.7550 0.4448
Subtotal (Total Children Is Unduplicated) 2080 37711.25000 219946.5950 5.8324
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Total 83596.000000 1471842.7250 17.6066
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Number of Children (Unduplicated) With at Least One Service 15345
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Center 01
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 1 2.000000 150.0000 0.0000
S 15 13.750000 597.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4658 3021.000000 81263.3800 0.0000
Other 86 95.500000 5937.1300 0.0000
---------------------------------------------------------
Total 4760 3132.250000 87948.2600 0.0000
Center 02
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 2 10.000000 4.4600 0.0000
10 11.250000 369.7500 0.0000
Other 2578 6833.250000 43932.8350 0.0000
---------------------------------------------------------
Total 2590 6854.500000 44307.0450 0.0000
Center 03
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 24 19.500000 914.4400 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
4698 3107.750000 86681.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4722 3127.250000 87596.1900 0.0000
Center 04
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 27 43.000000 1647.5000 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
2752 2672.750000 106604.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2779 2715.750000 108252.3000 0.0000
Center 05
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
2353 1621.500000 38155.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2353 1621.500000 38155.4800 0.0000
Center 06
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
6514 3265.500000 102279.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6514 3265.500000 102279.7700 0.0000
Center 07
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 2 4.000000 300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4867 3791.750000 101929.5950 543.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4869 3795.750000 102229.5950 543.0000
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 10491 8117.500000 279598.1300 279597.6300
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
108 115.750000 5784.6400 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10599 8233.250000 285382.7700 279627.6300
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 2 4.000000 40.0000 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
4051 2796.750000 83995.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4053 2800.750000 84035.5000 40.0000
Center 51
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
4362 3498.750000 88319.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4362 3498.750000 88319.4500 0.0000
Center 52
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 9 15.000000 477.1900 477.1900
H 0 0.000000 0.0000 0.0000
T 2009 20710.250000 41647.5250 38717.8600
2740 6000.250000 37679.5300 99.0800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4758 26725.500000 79804.2450 39294.1300
Center 53
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 2867 2236.000000 36051.4600 36051.4600
6234 4524.750000 76532.3100 0.0000
Other 127 121.250000 2557.5000 0.0000
---------------------------------------------------------
Total 9228 6882.000000 115141.2700 36051.4600
Center 54
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 2 3.000000 111.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2827 2150.000000 31463.5000 31453.5000
T 2409 1769.500000 25528.3000 25528.3000
3724 3015.750000 42943.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8962 6938.250000 100045.8000 56981.8000
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 4 2.500000 46.2500 83.2500
D 40 41.500000 1535.5000 0.0000
S 2 2.500000 92.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2764 1657.750000 55751.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2810 1704.250000 57425.8000 83.2500
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 1 1.000000 10.0000 10.0000
2615 2299.750000 90909.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2616 2300.750000 90919.2500 10.0000