CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 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 10488 12325.75000 455925.2500 36.9897
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7757 12075.25000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6457 18587.00000 687369.5000 36.9812
Subtotal (Total Children Is Unduplicated) 16201 42988.00000 1143294.7500 26.5957
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 6 7.000000 339.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 107 197.500000 9875.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 457 707.750000 35387.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 44.000000 3300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 23 26.500000 1860.0200 70.1894
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 6.500000 487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 21.000000 1493.0200 71.0962
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 46.000000 2538.0000 55.1739
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 299 424.005597 31123.8999 73.4045
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 117 170.500000 12196.8800 71.5360
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 83.500000 6262.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 474 592.500000 32229.1200 54.3951
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 201 310.000000 23107.5200 74.5404
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 13.000000 526.5000 40.5000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 57.2700 57.2700
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 110.7000 22.1400
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 46 92.000000 4575.0000 49.7283
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 34 35.000000 1786.7500 51.0500
Subtotal (Total Children Is Unduplicated) 1422 2785.755597 167409.8299 60.0949
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 19.6000 19.6000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 280 301.250000 15062.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 19 12.750000 318.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 979 1375.500000 68737.5000 49.9727
CONIP-CONIP-CONSULT, ITDS PHONE 67 41.250000 1031.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 74 95.000000 4750.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 134 219.500000 10975.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 3 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 234 356.000000 17800.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 7 4.500000 112.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 14 41.000000 3006.1200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 208 964.500000 48225.0000 50.0000
INTR-T1013-INTERPRETER 245 486.250000 24312.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1757 8999.000000 89960.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 11 32.250000 2303.9400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 16 53.500000 3622.0400 67.7017
PHY-97110HM-PT SESSION BY PT ASST 3 15.000000 857.4000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 207.750000 13894.0300 66.8786
TRAV-TRAVS-Travel by mile 482 30772.00000 13697.1500 0.4451
Subtotal (Total Children Is Unduplicated) 2680 43982.50000 318797.7800 7.2483
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Total 89756.255597 1629502.3599 18.1547
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16703
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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 40 48.500000 2849.4900 0.0000
S 93 97.750000 4970.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 5 5.000000 271.4400 271.4400
5407 3513.500000 103463.5100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5545 3664.750000 111555.1600 271.4400
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 2493 6839.000000 43583.7700 0.0000
---------------------------------------------------------
Total 2493 6839.000000 43583.7700 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 45 32.500000 1278.5000 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
5533 3565.750000 114370.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5578 3598.250000 115649.3700 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 4 2.500000 177.7500 177.7500
D 46 71.250000 2692.7500 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
2706 2371.000000 97325.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2756 2444.750000 100195.7700 177.7500
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 72 1153.250000 4431.4100 4431.4100
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
2453 1407.750000 42427.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2525 2561.000000 46858.4700 4431.4100
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
6477 3331.250000 101660.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6477 3331.250000 101660.5000 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 76 55.250000 2309.2500 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
5991 3581.750000 107736.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6067 3637.000000 110045.7500 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 8916 7220.000000 250983.2100 250983.2100
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
424 412.000000 15971.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9340 7632.000000 266955.0000 250983.2100
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 71 38.250000 1415.2500 0.0000
S 2 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5323 3709.750000 113673.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5396 3748.500000 115107.0000 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 1 0.500000 18.5000 0.0000
D 3 3.500000 186.0000 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
4625 2778.750000 91632.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4629 2782.750000 91837.1400 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 3 12.000000 105.5000 102.9500
D 5 5.750000 389.3400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2829 26154.500000 50583.2400 46249.3000
2850 1818.000000 41397.7500 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5687 27990.250000 92475.8300 46372.2500
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
10614 8085.250000 129837.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10614 8085.250000 129837.2200 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
11857 8964.250000 136725.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11857 8964.250000 136725.2100 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 14 26.750000 1977.7500 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
3187 1968.755597 67350.4199 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3201 1995.505597 69328.1699 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 9 12.500000 462.5000 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
2761 2469.250000 97225.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2770 2481.750000 97688.0000 0.0000