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: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 11274 12217.25000 451896.2500 36.9884
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8559 12980.50000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7051 22250.75000 822910.6500 36.9835
Subtotal (Total Children Is Unduplicated) 17159 47448.50000 1274806.9000 26.8672
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 15.000000 727.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 116 169.643000 8482.1500 50.0000
EXIT-EXIT-EXIT ASSESSMENT 501 756.250000 37812.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 28 38.262000 2710.2500 70.8340
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 21 30.000000 2217.3400 73.9113
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.000000 225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 31.000000 2172.5200 70.0813
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 55 63.500000 3459.2500 54.4764
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 369 533.376396 39044.4697 73.2025
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 108 151.500000 10544.6500 69.6017
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 75 95.000000 6890.6000 72.5326
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 591 703.000000 38567.0000 54.8606
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 275 399.000000 29344.8000 73.5459
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 33 33.000000 1584.4500 48.0136
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 119.6400 23.9280
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 18 23.000000 1150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 29 29.000000 1480.4500 51.0500
Subtotal (Total Children Is Unduplicated) 1682 3080.531396 186634.6697 60.5852
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 361 415.000000 20750.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 17 12.250000 306.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1039 1368.250000 68312.5000 49.9269
CONIP-CONIP-CONSULT, ITDS PHONE 42 24.250000 606.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 132 190.750000 9537.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.250000 6.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 157 245.250000 12262.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 269 433.000000 21650.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 1.000000 25.0000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 10 41.000000 3006.1200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 10.500000 262.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 264 1217.575000 60878.7500 50.0000
INTR-T1013-INTERPRETER 286 576.500000 28712.5000 49.8049
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1830 9401.000000 94010.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 26.500000 1781.7200 67.2347
PHY-97110-PT SESSION BY LICENSED PT 15 77.750000 5314.4600 68.3532
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 20.9800 20.9800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 60 363.000000 25617.7200 70.5722
TRAV-TRAVS-Travel by mile 557 37320.00000 16611.4700 0.4451
Subtotal (Total Children Is Unduplicated) 2904 51724.82500 369672.4700 7.1469
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Total 102253.856396 1831114.0397 17.9075
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Number of Children (Unduplicated) With at Least One Service 17686
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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 2 2.000000 105.5000 0.0000
S 6 7.250000 501.8200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6425 4104.750000 126805.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6433 4114.000000 127412.3800 0.0000
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 3353 12683.250000 52991.9700 0.0000
---------------------------------------------------------
Total 3353 12683.250000 52991.9700 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 18 10.500000 388.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 1.500000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
6496 4101.250000 133448.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6516 4113.250000 133907.9800 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 81 106.250000 3968.7500 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
3402 3091.500000 125572.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3483 3197.750000 129540.8900 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 192 850.750000 10581.0500 10581.0500
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
2734 1619.500000 44603.7500 250.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2926 2470.250000 55184.8000 10831.0500
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
7392 3967.250000 121670.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7392 3967.250000 121670.2500 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 1 0.250000 9.2500 0.0000
D 131 89.000000 3584.0000 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
6911 4147.500000 125302.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7043 4236.750000 128895.7500 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 8554 6796.750000 238505.5100 238505.5100
D 1 1.000000 71.4400 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
275 290.250000 12680.8700 92.5000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8830 7088.000000 251257.8200 238598.0100
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 101 66.250000 2451.2500 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
5712 4008.250000 121635.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5813 4074.500000 124087.0000 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 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
3797 2522.750000 87624.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3797 2522.750000 87624.5800 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 1 1.000000 37.0000 37.0000
D 4 8.000000 600.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 1 1.000000 50.0000 0.0000
T 3344 28077.000000 71626.4600 61136.0100
3172 2082.750000 49410.2600 36.5100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6523 30170.000000 121732.9700 61209.5200
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 27 27.000000 1396.6400 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
11898 8767.075000 147210.7300 17246.7500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11925 8794.075000 148607.3700 17246.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 83.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 1 0.250000 9.2500 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
12511 9524.250000 150729.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12513 9526.000000 150822.0000 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 28.000000 2100.0000 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
4192 2597.031396 88283.7797 29899.1000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4206 2625.031396 90383.7797 29899.1000
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 21 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
2943 2658.500000 106532.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2964 2671.000000 106994.5000 0.0000