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: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 11232 13905.25000 514208.0000 36.9794
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7765 17628.00000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6604 19563.50000 720281.2500 36.8176
Subtotal (Total Children Is Unduplicated) 16434 51096.75000 1234489.2500 24.1598
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 14 16.000000 776.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 112 156.500000 7275.0000 46.4856
EXIT-EXIT-EXIT ASSESSMENT 369 571.500000 28500.0000 49.8688
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 29.000000 2008.2400 69.2497
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 27 29.000000 2175.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.500000 192.5000 55.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 49.500000 2673.9700 54.0196
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 286 415.416663 29901.0197 71.9784
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 72 111.500000 7051.7400 63.2443
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 114.500000 8333.1200 72.7783
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 574 727.500000 39834.1100 54.7548
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 249 375.000000 27992.0000 74.6453
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 40 40.000000 1620.0000 40.5000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 199.2600 22.1400
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 1 2.000000 102.1000 51.0500
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 2.000000 51.0500 25.5250
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 21 34.000000 1700.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 1423 2715.416663 162262.3097 59.7560
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 20.9800 20.9800
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 313 297.750000 14887.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 6 4.000000 100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1092 1701.000000 84887.5000 49.9045
CONIP-CONIP-CONSULT, ITDS PHONE 56 22.250000 556.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 9 8.500000 425.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 2 2.000000 146.6400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 12.000000 300.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 15.000000 750.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 186 898.000000 44900.0000 50.0000
INTR-T1013-INTERPRETER 238 445.000000 22235.0000 49.9663
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1595 8383.000000 83820.0000 9.9988
OCCT-97530-OT SESSION BY LICENSED OT 7 14.500000 757.5800 52.2469
PHY-97110-PT SESSION BY LICENSED PT 13 44.500000 3137.6400 70.5088
PHY-97110HM-PT SESSION BY PT ASST 4 32.000000 1656.4800 51.7650
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 199.750000 13834.8400 69.2608
TRAV-TRAVS-Travel by mile 454 31702.00000 14109.8100 0.4451
Subtotal (Total Children Is Unduplicated) 2322 43783.25000 286575.2200 6.5453
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Total 97595.416663 1683326.7797 17.2480
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Number of Children (Unduplicated) With at Least One Service 16856
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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 2 1.750000 37.0000 0.0000
S 3 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 20.0000 20.0000
6265 4022.750000 112867.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6272 4028.500000 112998.2500 20.0000
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 0 0.000000 0.0000 0.0000
7 7.000000 298.3200 0.0000
Other 3304 8550.250000 58498.2400 0.0000
---------------------------------------------------------
Total 3311 8557.250000 58796.5600 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 1 1.000000 0.0000 50.0000
D 40 14.000000 518.0000 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
6891 4095.500000 122339.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6932 4110.500000 122857.4100 50.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 4.000000 148.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 44 61.750000 2284.7500 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
2748 2605.250000 104791.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2793 2671.000000 107224.5100 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 5 82.500000 111.0500 111.0500
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
2593 1904.250000 49666.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2598 1986.750000 49777.3500 111.0500
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
7082 3562.250000 111645.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7082 3562.250000 111645.7500 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
5816 3709.500000 109123.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5816 3709.500000 109123.0000 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 10493 7916.500000 271361.5500 271374.0500
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
28 28.750000 1657.6400 122.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10521 7945.250000 273019.1900 271496.9300
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 1 2.000000 100.0000 100.0000
D 5 1.750000 64.7500 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
4802 3382.500000 104363.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4808 3386.250000 104528.2500 100.0000
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 2 30.000000 900.0000 900.0000
D 8 3.500000 129.5000 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
5415 3298.000000 107505.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5425 3331.500000 108534.8100 900.0000
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 2 4.000000 111.9400 111.9400
D 0 0.000000 0.0000 0.0000
S 141 172.750000 8222.8300 5268.3100
H 0 0.000000 0.0000 0.0000
T 2515 26628.750000 54641.8600 50077.2800
3015 6965.000000 39114.2700 17.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5673 33770.500000 102090.9000 55475.1000
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 1 1.250000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 20.9800 20.9800
10625 7909.500000 131418.5700 0.0000
Other 101 95.250000 2065.0000 0.0000
---------------------------------------------------------
Total 10728 8007.000000 133504.5500 20.9800
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
10816 7947.250000 120533.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10816 7947.250000 120533.5000 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 30 43.000000 2503.0000 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
3210 2055.416663 70020.7497 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3240 2098.416663 72523.7497 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 8 8.000000 352.5000 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
2880 2475.500000 95816.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2888 2483.500000 96169.0000 0.0000