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:TPIN
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 12 4.500000 166.5000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 0.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 234 440.500000 16289.2500 36.9790
Subtotal (Total Children Is Unduplicated) 238 445.750000 16455.7500 36.9170
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 37 64.000000 12400.0000 193.7500
EXIT-EXIT-EXIT ASSESSMENT 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 33.000000 2378.1300 72.0645
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.500000 637.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 11.000000 637.5000 57.9545
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 27.500000 1488.5300 54.1284
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 302 546.953934 40000.9200 73.1340
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 129 210.353700 14903.6700 70.8505
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 94.069600 7055.2100 74.9999
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 283 502.500000 27648.7900 55.0225
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 172 285.500000 21375.0000 74.8687
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.000000 1520.0000 304.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 193.0000 193.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 1.000000 51.0500 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 15 18.000000 867.8500 48.2139
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 4 3.447200 175.9800 51.0501
PSTH-97001-EVAL BY LICENSED PT, INITIAL 12 12.000000 716.5700 59.7142
SCREEN-T1023-SCREENING 14 14.000000 700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 13.881489 708.6500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 1.090000 56.0500 51.4220
Subtotal (Total Children Is Unduplicated) 653 1860.795923 134041.4400 72.0345
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 3.000000 640.4100 213.4700
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 5.750000 287.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 0.500000 25.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 222 1125.300000 56752.5000 50.4332
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 4 5.000000 50.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 116 513.329466 37155.2000 72.3808
OCCT-97530HM-OT SESSION BY OT ASST 22 62.125527 3553.5800 57.2000
PHY-97110-PT SESSION BY LICENSED PT 153 675.440419 58921.1800 87.2337
PHY-97110HM-PT SESSION BY PT ASST 21 72.339123 3946.2600 54.5522
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 212 930.819035 77613.9500 83.3824
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.500000 85.8000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 4 12.250000 170.0300 13.8800
TRAV-TRAVS-Travel by mile 9 166.000000 73.9000 0.4452
Subtotal (Total Children Is Unduplicated) 651 3576.353570 239350.3100 66.9258
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Total 5882.899493 389847.5000 66.2679
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Number of Children (Unduplicated) With at Least One Service 1320
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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 6 6.000000 410.7800 285.7600
12 12.000000 835.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 18.000000 1246.6200 285.7600
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 278 270.750000 53464.3200 0.0000
T 0 0.000000 0.0000 0.0000
13 10.250000 1157.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 291 281.000000 54621.9100 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 4 4.000000 296.4400 751.8700
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
61 60.000000 5739.0500 0.0000
Other 46 108.000000 7353.0400 645.1400
---------------------------------------------------------
Total 111 172.000000 13388.5300 1397.0100
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 2 2.000000 122.4900 122.4900
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
36 51.000000 3761.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 38 53.000000 3884.3800 122.4900
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
670 609.250000 31432.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 670 609.250000 31432.0400 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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9 11.000000 550.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 11.000000 550.0000 0.0000
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 164 164.500000 11764.3400 270829.0300
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
152 299.500000 21325.1200 300.5400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 316 464.000000 33089.4600 271129.5700
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 1.500000 65.4500 25.4500
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
548 1197.500000 80806.0200 511.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 550 1199.000000 80871.4700 537.3100
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
61 136.000000 9440.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 61 136.000000 9440.5600 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 51 86.000000 2786.7100 2648.7300
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 5 123.500000 180.5600 180.5600
556 777.750000 47369.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 612 987.250000 50336.5900 2829.2900
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 0 0.000000 0.0000 0.0000
623 707.050000 36770.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 623 707.050000 36770.9300 0.0000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
483 519.990000 26192.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 483 519.990000 26192.9900 0.0000
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 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
587 402.359493 27318.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 600 428.359493 29268.2000 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
128 297.000000 18753.8200 17223.8200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 128 297.000000 18753.8200 17223.8200