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: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 13590 40805.00000 1507430.2500 36.9423
Subtotal (Total Children Is Unduplicated) 13590 40805.00000 1507430.2500 36.9423
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.8400 21.8400
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 66 101.500000 7612.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 82.500000 6187.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 15 21.500000 1612.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 71.500000 5362.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 119 178.000000 9879.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 959 1417.000000 106020.0000 74.8200
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 326 496.000000 37137.5000 74.8740
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 312 429.000000 32093.9400 74.8110
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1346 1996.000000 110750.2500 55.4861
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 675 970.500000 72687.5000 74.8970
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 20 20.000000 810.0000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 44.2800 22.1400
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 35 35.000000 1786.7500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 10 10.000000 510.5000 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 20 20.000000 1021.0000 51.0500
SCREEN-T1023-SCREENING 60 65.000000 3250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 43 44.000000 2246.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 2182 5973.500000 399709.8500 66.9138
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 3.000000 427.1800 142.3933
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 20.000000 500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4607 33894.00000 1693297.2600 49.9586
OCCT-97530-OT SESSION BY LICENSED OT 265 1418.000000 101222.5800 71.3840
OCCT-97530HM-OT SESSION BY OT ASST 87 316.500000 18103.7200 57.1997
PHY-97110-PT SESSION BY LICENSED PT 283 1583.000000 112901.2000 71.3210
PHY-97110HM-PT SESSION BY PT ASST 73 355.750000 20303.5900 57.0726
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 602 3705.250000 263719.4000 71.1745
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 30 58.500000 3346.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 21.500000 267.3800 12.4363
Subtotal (Total Children Is Unduplicated) 5383 41375.50000 2214088.5100 53.5121
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Total 88154.000000 4121228.6100 46.7503
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Number of Children (Unduplicated) With at Least One Service 14421
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 6.500000 231.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7848 5027.500000 185228.4400 9.2500
P 27 27.000000 1458.2400 1458.2400
D 2 1.750000 64.7500 0.0000
S 290 246.500000 9120.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 4.000000 221.4400 221.4400
13 6.750000 249.7500 0.0000
Other 10 8.000000 296.0000 0.0000
---------------------------------------------------------
Total 8210 5328.000000 196870.6200 1688.9300
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 18 18.000000 1228.7600 541.4700
67 68.000000 4404.4400 0.0000
Other 1693 1251.250000 51011.5000 0.0000
---------------------------------------------------------
Total 1778 1337.250000 56644.7000 541.4700
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.500000 213.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 1591 983.500000 38967.5000 0.0000
P 2198 1330.500000 54683.7500 55096.5860
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 53 52.500000 3730.2100 0.0000
T 0 0.000000 0.0000 0.0000
6 2.750000 149.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3852 2372.750000 97744.2000 55096.5860
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 199.500000 8369.5000 0.0000
P 2862 4133.750000 160339.8900 160393.0100
D 1 0.750000 27.7500 0.0000
S 2 4.250000 157.2500 0.0000
H 2321 8119.000000 408962.2400 0.0000
T 0 0.000000 0.0000 0.0000
389 562.750000 34555.4500 0.0000
Other 1 1.000000 51.0500 0.0000
---------------------------------------------------------
Total 5727 13021.000000 612463.1300 160393.0100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1309.750000 53341.7500 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
1 1.000000 51.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2045 1312.250000 53448.3000 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
4693 3172.000000 130914.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4693 3172.000000 130914.5200 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 5.500000 203.5000 64.7500
P 5097 3732.250000 149042.7500 149024.2500
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
109 166.250000 8298.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5217 3905.000000 157581.2800 149089.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 92 100.750000 5069.0000 58.5000
P 4182 4057.000000 173147.9400 173147.9400
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
1721 5414.000000 294082.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5996 9574.500000 472400.7100 173206.4400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 12.250000 453.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4360 3445.750000 157163.7500 0.0000
P 2718 1783.250000 66056.2500 66056.2500
D 1 0.500000 18.5000 18.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2771 9190.250000 478821.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9866 14432.000000 702513.5500 66074.7500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 12.750000 471.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2806 1836.500000 70173.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 17 10.500000 388.5000 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
873 2493.000000 149924.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3714 4352.750000 220958.1300 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 300.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2032 1832.500000 84915.2500 35.0000
P 741 603.250000 24690.7000 24653.7000
D 21 7.500000 311.9400 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
866 1469.500000 90388.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3663 3917.000000 200615.8200 24688.7000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 127 93.000000 3587.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2041 1856.750000 80312.5000 0.0000
P 1885 1797.500000 83583.0000 83527.5000
D 0 0.000000 0.0000 0.0000
S 5 8.750000 551.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1412 1457.000000 74420.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5470 5213.000000 242455.5900 83527.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5041 4245.250000 181949.3000 0.0000
P 116 117.750000 6074.7500 6074.7500
D 1 1.000000 37.0000 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
2871 2833.750000 142580.4100 0.0000
Other 2 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 8033 7202.750000 330826.4600 6074.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 12.500000 538.5000 0.0000
P 2629 2464.750000 99631.7500 99661.0000
D 0 0.000000 0.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3127 2816.000000 185505.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5772 5295.500000 285758.5200 99661.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3762 3628.250000 145901.5000 111.0000
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 1 1.000000 75.0000 0.0000
T 4 11.000000 537.0000 500.0000
1336 4078.000000 213519.5800 213019.5800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5103 7718.250000 360033.0800 213630.5800