CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Payclass Filters:GR
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 941 998.500000 36898.2500 36.9537
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 718 960.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 602 2068.000000 76442.0000 36.9642
Subtotal (Total Children Is Unduplicated) 1410 4027.250000 113340.2500 28.1433
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 35 59.500000 2650.0000 44.5378
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 1.000000 60.0000 60.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 140.2900 46.7633
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 4.000000 147.6500 36.9125
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 161 248.538233 17529.6800 70.5311
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 63.459600 4521.3000 71.2469
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 75.335622 5466.5000 72.5620
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 246 350.500000 19189.1900 54.7480
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 85 132.018930 9901.4197 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.000000 405.0000 40.5000
SCREEN-T1023-SCREENING 5 8.000000 400.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 414 963.852385 60974.5797 63.2613
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 4 3.250000 137.5000 42.3077
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.500000 75.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.750000 37.5000 50.0000
INTR-T1013-INTERPRETER 42 85.500000 4171.9700 48.7950
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 237 414.000000 4077.6300 9.8493
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 237.8700 59.4675
TRAV-TRAVS-Travel by mile 182 6154.000000 2739.1800 0.4451
Subtotal (Total Children Is Unduplicated) 359 6663.000000 11476.6500 1.7224
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Total 11654.102385 185791.4797 15.9422
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Number of Children (Unduplicated) With at Least One Service 1493
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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 30 267.250000 847.3600 847.3600
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 15 63.000000 361.3600 361.3600
356 274.000000 8389.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 401 604.250000 9598.0600 1208.7200
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 67 1682.000000 3537.6500 2745.3600
0 0.000000 0.0000 0.0000
Other 257 302.000000 4440.1300 0.0000
---------------------------------------------------------
Total 324 1984.000000 7977.7800 2745.3600
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 2 1.250000 46.2500 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
786 632.500000 28241.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 788 633.750000 28288.2200 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 1 3.750000 138.7500 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
216 242.500000 10041.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 217 246.250000 10180.0500 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 50 504.250000 1924.4500 1943.3700
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
257 224.250000 5737.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 307 728.500000 7661.7400 1943.3700
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
264 162.250000 5141.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 264 162.250000 5141.2500 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 44 56.250000 2228.2500 2228.2500
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
662 568.750000 17917.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 706 625.000000 20145.5000 2228.2500
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 568 601.000000 24421.0400 24418.5400
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
4 6.000000 410.0000 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 572 607.000000 24831.0400 24458.5400
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 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
346 344.250000 12605.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 346 344.250000 12605.5000 0.0000
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 32 33.500000 1262.8800 1262.8800
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
307 232.000000 7243.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 339 265.500000 8506.6300 1262.8800
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 17 33.500000 1346.2900 1078.0000
H 0 0.000000 0.0000 0.0000
T 106 1448.000000 1625.2200 1624.7300
302 242.750000 6012.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 425 1724.250000 8984.0100 2702.7300
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 35 206.000000 482.4600 482.4600
T 31 327.500000 410.5000 410.5000
594 644.250000 7531.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 660 1177.750000 8424.6300 892.9600
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 39 277.000000 852.3400 852.3400
T 29 155.502222 341.6400 341.6400
556 655.750000 7279.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 624 1088.252222 8473.9400 1193.9800
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 26 48.331233 3446.8300 3446.8300
D 6 8.000000 448.0000 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
475 346.268930 13087.1697 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 507 402.600163 16981.9997 3446.8300
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 24 889.000000 697.6300 697.6300
151 171.500000 7293.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 175 1060.500000 7991.1300 697.6300