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: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 13600 39839.50000 1472927.7500 36.9715
Subtotal (Total Children Is Unduplicated) 13600 39839.50000 1472927.7500 36.9715
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 89 128.500000 9637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 57 75.500000 5662.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 17.000000 1275.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 40 69.000000 5175.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 122 176.500000 9768.0000 55.3428
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 934 1390.000000 104147.5200 74.9263
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 494 694.500000 52087.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 223 287.000000 21462.5000 74.7822
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1258 1812.500000 100525.7500 55.4625
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 502 774.000000 57937.5000 74.8547
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 35.000000 1417.5000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 3 3.000000 171.8100 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 110.7000 22.1400
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 70 75.000000 3750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 2209 5554.500000 373741.3800 67.2862
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 18 47.000000 3446.0400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 16.750000 418.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 976 4623.250000 231088.5000 49.9840
OCCT-97530-OT SESSION BY LICENSED OT 23 60.000000 4286.4000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 33 92.000000 6572.4800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 31.000000 1771.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 79 323.500000 23110.8400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 1111 5194.500000 270708.8500 52.1145
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Total 50588.500000 2117377.9800 41.8549
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Number of Children (Unduplicated) With at Least One Service 13827
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 20.500000 758.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 7748 5148.000000 190947.0200 0.2500
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 445 435.750000 23892.0500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.5000 0.0000
11 9.500000 553.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8251 5614.250000 216169.4500 0.2500
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
0 0.000000 0.0000 0.0000
Other 1658 1135.750000 46650.7500 0.0000
---------------------------------------------------------
Total 1658 1135.750000 46650.7500 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 201 133.500000 6193.9400 0.0000
P 3614 2248.500000 92913.2500 30577.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 46 44.500000 3158.6900 0.0000
T 0 0.000000 0.0000 0.0000
5 6.750000 419.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3866 2433.250000 102685.8200 30577.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 759 1102.250000 44402.7500 0.0000
P 2426 3503.250000 138115.6600 138285.7400
D 0 0.000000 0.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
442 523.000000 23519.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3629 5132.500000 206185.5100 138285.7400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2352 1598.250000 66439.5000 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 2352 1598.250000 66439.5000 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
4658 3304.000000 137889.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4658 3304.000000 137889.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 3.750000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 359 251.000000 9485.5000 0.0000
P 4853 3636.000000 146864.2500 146836.5000
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
5 4.250000 183.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5224 3895.000000 156671.7500 146836.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 231 218.500000 8561.2500 12.5000
P 4330 4145.500000 174148.7700 173323.7500
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 4561 4364.000000 182710.0200 173336.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1235 961.750000 45407.5000 0.0000
P 3909 2834.500000 125446.2500 125446.2500
D 0 0.000000 0.0000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3 2.250000 83.2500 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 5149 3799.250000 170964.7500 125446.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2850 1762.250000 67726.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 10 4.500000 166.5000 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
48 110.000000 7517.4800 0.0000
Other 2 2.500000 187.5000 0.0000
---------------------------------------------------------
Total 2910 1879.250000 75597.4800 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 17.500000 1255.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2224 2144.750000 90675.5000 0.0000
P 446 524.250000 30886.3300 29972.1300
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
204 175.000000 12236.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2884 2861.500000 135054.1900 29972.1300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1785 1691.500000 78371.5400 0.0000
P 1900 1749.000000 77322.0000 77272.0000
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
442 466.000000 19282.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4129 3908.750000 175059.2900 77272.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 100.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5067 4110.500000 171562.0000 0.0000
P 720 749.750000 39423.2500 39423.2500
D 0 0.000000 0.0000 0.0000
S 21 21.500000 1187.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
44 37.000000 1590.7500 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 5857 4923.500000 213965.2500 39423.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 146 112.750000 4171.7500 3496.5000
P 2234 2149.000000 86767.2500 88112.2500
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
92 84.000000 5256.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2472 2345.750000 96195.9700 91608.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3447 3386.000000 134692.2500 0.0000
P 9 7.500000 447.0000 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 3456 3393.500000 135139.2500 0.0000