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: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 13499 40649.75000 1501686.0000 36.9421
Subtotal (Total Children Is Unduplicated) 13499 40649.75000 1501686.0000 36.9421
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Screening, Eval, and Assessment,Class #02
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 57 81.500000 6112.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 16.000000 1200.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 44 66.500000 4987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 103 151.000000 8380.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 870 1286.000000 96195.0000 74.8017
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 303 465.000000 34812.5000 74.8656
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 256 326.000000 24368.9400 74.7513
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1257 1835.000000 101814.7500 55.4849
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 594 838.000000 62750.0000 74.8807
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 4 4.000000 204.2000 51.0500
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 60 65.000000 3250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
Subtotal (Total Children Is Unduplicated) 2034 5269.500000 353167.7100 67.0211
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 18.000000 450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 800 4028.500000 201350.0000 49.9814
OCCT-97530-OT SESSION BY LICENSED OT 10 60.500000 4257.0200 70.3640
PHY-97110-PT SESSION BY LICENSED PT 23 54.500000 3812.3200 69.9508
PHY-97110HM-PT SESSION BY PT ASST 3 31.000000 1740.8800 56.1574
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 336.500000 23679.6600 70.3705
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.000000 171.6000 57.2000
Subtotal (Total Children Is Unduplicated) 889 4532.000000 235461.4800 51.9553
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Total 50451.250000 2090315.1900 41.4324
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Number of Children (Unduplicated) With at Least One Service 13642
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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 0 0.000000 0.0000 0.0000
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 0 0.000000 0.0000 0.0000
13 6.750000 249.7500 0.0000
Other 10 8.000000 296.0000 0.0000
---------------------------------------------------------
Total 8179 5297.000000 195190.9400 9.2500
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
2 2.000000 50.0000 0.0000
Other 1692 1249.250000 50900.5000 0.0000
---------------------------------------------------------
Total 1694 1251.250000 50950.5000 0.0000
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 135 182.750000 7749.7500 0.0000
P 2684 3995.500000 155224.6400 155277.7600
D 1 0.750000 27.7500 0.0000
S 2 4.250000 157.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
276 276.500000 14522.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3098 4459.750000 177681.5500 155277.7600
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2044 1311.250000 53397.2500 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
63 50.250000 2024.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5171 3789.000000 151307.5000 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
1 2.000000 111.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4276 4162.500000 178429.6900 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
11 15.000000 568.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7106 5256.750000 224259.7500 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
49 130.250000 9080.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2890 1990.000000 80114.1500 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 2031 1830.500000 84765.2500 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
405 332.500000 21820.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3201 2778.000000 131897.1500 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
100 90.000000 4102.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4158 3846.000000 172137.0000 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
325 242.250000 9406.5000 0.0000
Other 2 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 5487 4611.250000 197652.5500 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
39 40.000000 2071.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2684 2519.500000 102324.9400 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 1 1.000000 37.0000 0.0000
4 4.000000 300.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3768 3634.250000 146313.5000 111.0000