CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 50.6200 25.3100
EVAL-96111-DEVELOPMENTAL EVALUATION 2 5.050400 252.5200 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 68.819000 5012.5100 72.8361
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 23.779100 1783.4200 74.9995
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 56.233400 4217.5000 74.9999
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 21 39.000000 2164.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 14.918800 1015.2400 68.0510
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 14 65.000000 3250.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 150.0900 50.0300
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 561.5500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 23.000000 1153.1000 50.1348
Subtotal (Total Children Is Unduplicated) 174 342.300700 21438.2000 62.6297
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 299.0000 299.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 7.000000 350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 2.000000 100.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 4 4.000000 200.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 176 638.133800 32056.6900 50.2351
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2 9.000000 90.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 149 493.556437 34122.7700 69.1365
OCCT-97530HM-OT SESSION BY OT ASST 43 159.528342 9097.7800 57.0292
PHY-97110-PT SESSION BY LICENSED PT 212 855.699607 117873.4251 137.7509
PHY-97110HM-PT SESSION BY PT ASST 19 77.775700 4445.6600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 338 1381.688068 95036.3600 68.7828
SPL-92508-GROUP SPL SESSION PER CHILD 2 3.000000 99.2000 33.0667
TRAV-TRAVS-Travel by mile 2 162.000000 72.0900 0.4450
Subtotal (Total Children Is Unduplicated) 796 3800.381954 294017.9751 77.3654
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Total 4142.682654 315456.1751 76.1478
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Number of Children (Unduplicated) With at Least One Service 932
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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 145 149.000000 8537.4600 8537.4600
D 166 167.500000 9683.0900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 45 45.000000 2673.0400 2673.0400
2 2.000000 100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 358 363.500000 20993.5900 11210.5000
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 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
14 14.000000 614.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14 14.000000 614.5900 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 12 35.500000 2252.7800 2252.7800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 18.000000 1065.7300 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 43 101.500000 6627.2700 1746.5500
---------------------------------------------------------
Total 61 155.000000 9945.7800 3999.3300
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 2 4.000000 265.3700 285.7600
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 2 4.000000 265.3700 285.7600
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 15 7.500000 535.8000 535.8000
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
626 425.250000 29817.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 641 432.750000 30353.2300 535.8000
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 71 155.000000 9963.7400 9963.7400
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
4 5.250000 350.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 75 160.250000 10314.0400 9963.7400
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 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
280 759.500000 52950.7900 0.0000
Other 18 28.500000 2137.5000 0.0000
---------------------------------------------------------
Total 298 788.000000 55088.2900 0.0000
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 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
226 441.750000 86414.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 226 441.750000 86414.3200 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
12 33.500000 2393.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 33.500000 2393.2400 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 31 75.500000 4682.1300 4682.1300
131 249.250000 15070.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 162 324.750000 19752.4700 4682.1300
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 4 5.000000 300.0000 300.0000
195 196.302600 9943.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 199 201.302600 10243.9700 300.0000
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
189 349.500000 10263.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 189 349.500000 10263.8400 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 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
787 590.880054 39214.1151 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 787 590.880054 39214.1151 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 13 7.000000 479.6900 479.6900
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 4 12.500000 807.2400 807.2400
159 264.000000 18312.4000 18312.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 176 283.500000 19599.3300 19599.3300