CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2016 ending 09/30/2016 Date of Report:10/31/2016 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 11180 13227.75000 489275.2500 36.9885
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7504 11857.50000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6468 19164.75000 708252.7500 36.9560
Subtotal (Total Children Is Unduplicated) 16324 44250.00000 1197528.0000 27.0628
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 16.000000 776.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 90 112.000000 5575.0000 49.7768
EXIT-EXIT-EXIT ASSESSMENT 444 675.000000 33750.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 35 42.000000 2960.0000 70.4762
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 29 30.500000 2287.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 9.500000 712.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 16 18.000000 1310.0000 72.7778
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 48 54.000000 2997.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 235 314.717600 22681.2400 72.0685
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 149.500000 10519.1500 70.3622
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 73.500000 5442.5000 74.0476
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 434 512.500000 28182.0200 54.9893
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 199 279.000000 20398.5200 73.1130
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.000000 405.0000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 114.5400 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 88.5600 22.1400
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 38 59.000000 2950.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 27.000000 1378.3500 51.0500
Subtotal (Total Children Is Unduplicated) 1352 2390.217600 142629.9800 59.6724
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 235 290.750000 14534.2500 49.9888
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 5 1.500000 37.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 974 1271.750000 63543.7500 49.9656
CONIP-CONIP-CONSULT, ITDS PHONE 23 9.750000 243.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 50 58.750000 2937.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 80 100.250000 5012.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 142 193.500000 9675.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 3 1.500000 37.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.000000 100.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 199 747.500000 37375.0000 50.0000
INTR-T1013-INTERPRETER 245 582.750000 29137.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1742 9044.000000 90351.0000 9.9902
OCCT-97530-OT SESSION BY LICENSED OT 6 29.750000 2125.3400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 10 19.000000 1305.9200 68.7326
PHY-97110HM-PT SESSION BY PT ASST 1 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 52 236.750000 16107.6200 68.0364
TRAV-TRAVS-Travel by mile 484 29322.00000 13049.2500 0.4450
Subtotal (Total Children Is Unduplicated) 2513 41917.50000 285794.8600 6.8180
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Total 88557.717600 1625952.8400 18.3604
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Number of Children (Unduplicated) With at Least One Service 16807
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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 0 0.000000 0.0000 0.0000
S 60 58.750000 2402.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 16 42.750000 429.8100 429.4200
6073 4190.750000 122390.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6149 4292.250000 125223.1600 429.4200
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 1 0.500000 18.5000 0.0000
0 0.000000 0.0000 0.0000
Other 2827 5550.500000 42175.3100 0.0000
---------------------------------------------------------
Total 2828 5551.000000 42193.8100 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 0 0.000000 0.0000 0.0000
D 44 26.000000 968.5000 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
5629 3235.500000 94548.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5673 3261.500000 95517.0200 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 0 0.000000 0.0000 0.0000
D 31 52.000000 1924.0000 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
2777 2479.250000 102332.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2808 2531.250000 104256.1100 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 14 1507.750000 1307.0000 1307.0000
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
2562 2167.750000 50065.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2576 3675.500000 51372.8500 1307.0000
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
7652 4001.500000 125741.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7652 4001.500000 125741.7900 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
5882 3476.000000 102530.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5882 3476.000000 102530.5000 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 6895 5305.750000 185120.3600 185120.3600
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
3752 2911.750000 103609.1600 1449.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10647 8217.500000 288729.5200 186570.1500
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 30 25.250000 1048.2500 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
2812 1905.500000 53589.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2842 1930.750000 54637.5000 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
5153 3128.250000 102488.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5153 3128.250000 102488.6900 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 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 2442 25022.250000 54174.0300 49186.7000
2829 1803.500000 39931.8900 10.8900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5271 26825.750000 94105.9200 49197.5900
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
10915 8440.500000 132189.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10915 8440.500000 132189.7000 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
11465 8574.000000 131131.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11465 8574.000000 131131.7500 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 1 2.000000 150.0000 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
2998 1969.717600 70319.5200 47739.1600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2999 1971.717600 70469.5200 47739.1600
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 13 17.500000 704.0000 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
2943 2662.750000 104661.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2956 2680.250000 105365.0000 0.0000