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
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 104 155.250000 5744.2500 37.0000
Subtotal (Total Children Is Unduplicated) 104 155.250000 5744.2500 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 21.8400 21.8400
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 27.000000 1498.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 89 131.000000 9825.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 31.000000 2325.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 56 103.000000 7725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 89 161.000000 8935.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 81 132.500000 9937.5000 75.0000
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 2 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 31 31.000000 1582.5500 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 9 9.000000 459.4500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 17 17.000000 867.8500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 37 38.000000 1939.9000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 8 9.000000 459.4500 51.0500
Subtotal (Total Children Is Unduplicated) 421 704.000000 46542.1400 66.1110
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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 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3847 29865.50000 1491947.2600 49.9555
OCCT-97530-OT SESSION BY LICENSED OT 255 1357.500000 96965.5600 71.4295
OCCT-97530HM-OT SESSION BY OT ASST 87 316.500000 18103.7200 57.1997
PHY-97110-PT SESSION BY LICENSED PT 260 1528.500000 109088.8800 71.3699
PHY-97110HM-PT SESSION BY PT ASST 70 324.750000 18562.7100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 540 3368.750000 240039.7400 71.2548
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 55.500000 3174.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 21.500000 267.3800 12.4363
Subtotal (Total Children Is Unduplicated) 4588 36843.50000 1978627.0300 53.7036
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Total 37702.750000 2030913.4200 53.8665
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Number of Children (Unduplicated) With at Least One Service 4923
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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 27 27.000000 1458.2400 1458.2400
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 4 4.000000 221.4400 221.4400
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 31.000000 1679.6800 1679.6800
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
65 66.000000 4354.4400 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 84 86.000000 5694.2000 541.4700
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 16.750000 619.7500 0.0000
P 178 138.250000 5115.2500 5115.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2321 8119.000000 408962.2400 0.0000
T 0 0.000000 0.0000 0.0000
113 286.250000 20033.2900 0.0000
Other 1 1.000000 51.0500 0.0000
---------------------------------------------------------
Total 2629 8561.250000 434781.5800 5115.2500
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
1 1.000000 51.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 51.0500 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
46 116.000000 6273.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 46 116.000000 6273.7800 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 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
1720 5412.000000 293971.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1720 5412.000000 293971.0200 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 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
2760 9175.250000 478253.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2760 9175.250000 478253.8000 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 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
824 2362.750000 140843.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 824 2362.750000 140843.9800 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 1 2.000000 150.0000 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
461 1137.000000 68568.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 462 1139.000000 68718.6700 0.0000
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
1312 1367.000000 70318.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1312 1367.000000 70318.5900 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
2546 2591.500000 133173.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2546 2591.500000 133173.9100 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3088 2776.000000 183433.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3088 2776.000000 183433.5800 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 3 10.000000 500.0000 500.0000
1332 4074.000000 213219.5800 213019.5800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1335 4084.000000 213719.5800 213519.5800