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: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 14489 43977.00000 1626116.6900 36.9765
Subtotal (Total Children Is Unduplicated) 14489 43977.00000 1626116.6900 36.9765
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 86 126.500000 9487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 37 50.500000 3787.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 21.500000 1612.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 69 107.000000 8025.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 100 153.000000 8491.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1085 1613.000000 120895.0000 74.9504
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 484 653.000000 48920.7500 74.9169
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 259 346.000000 25950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1274 1869.000000 103577.0200 55.4184
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 676 981.500000 73612.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 36 36.000000 1875.6000 52.1000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 75.7200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 181.8000 25.9714
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 74 78.000000 3900.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2425 6051.000000 410800.7900 67.8897
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 4 7.000000 513.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 20.000000 500.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1000 4930.000000 246500.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 24 101.500000 7251.1600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 46 206.000000 14716.6400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 5 29.000000 1657.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 49 179.250000 12805.6200 71.4400
Subtotal (Total Children Is Unduplicated) 1111 5472.750000 283944.3000 51.8833
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Total 55500.750000 2320861.7800 41.8168
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Number of Children (Unduplicated) With at Least One Service 14643
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 73.000000 4689.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 8307 5391.250000 205731.0200 0.0000
P 5 7.000000 500.0000 500.0000
D 80 79.750000 5568.1900 0.0000
S 301 330.000000 22627.5400 0.0000
H 1 1.500000 112.5000 0.0000
T 0 0.000000 0.0000 0.0000
19 13.000000 481.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8799 5895.500000 239710.1900 500.0000
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 1844 1382.000000 60852.5000 0.0000
---------------------------------------------------------
Total 1844 1382.000000 60852.5000 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 983 608.750000 23915.0000 100.0000
P 2155 1341.250000 55341.7500 39978.0250
D 0 0.000000 0.0000 0.0000
S 5 4.250000 157.2500 0.0000
H 78 72.000000 5102.9000 0.0000
T 0 0.000000 0.0000 0.0000
101 62.750000 2872.7900 0.0000
Other 60 48.500000 1937.5000 0.0000
---------------------------------------------------------
Total 3382 2137.500000 89327.1900 40078.0250
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 695 897.750000 39948.0000 0.0000
P 3135 4722.750000 185843.3900 186007.9000
D 0 0.000000 0.0000 0.0000
S 2 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
513 650.000000 29747.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4346 6273.500000 255668.1200 186007.9000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2834 1909.250000 77157.7500 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 2835 1910.250000 77194.7500 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
4801 3406.250000 139571.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4801 3406.250000 139571.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 13 9.250000 342.2500 0.0000
P 5534 3973.000000 160105.0000 160058.7500
D 0 0.000000 0.0000 0.0000
S 3 1.250000 46.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
19 16.750000 645.7500 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 5572 4002.000000 161204.0000 160058.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.500000 129.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 220 191.750000 7419.7500 27.7500
P 3857 3758.500000 157651.7700 157651.7700
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
1 1.000000 50.0000 0.0000
Other 2 3.500000 223.5000 0.0000
---------------------------------------------------------
Total 4082 3958.250000 165474.5200 157679.5200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 529 368.000000 13616.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7035 5144.750000 217016.5000 0.0000
P 1709 1224.250000 54837.0000 54837.0000
D 1 0.250000 9.2500 0.0000
S 61 33.500000 1391.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
26 31.000000 1147.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9361 6801.750000 288017.2500 54837.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2315 1476.250000 57329.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 8 3.250000 120.2500 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
11 11.000000 636.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2339 1496.000000 58288.9500 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 265 188.750000 7672.0000 37.0000
P 2843 2546.000000 116675.4600 115715.6300
D 18 16.250000 1111.9500 0.0000
S 5 5.750000 212.7500 0.0000
H 27 22.750000 1513.0800 46.9000
T 0 0.000000 0.0000 0.0000
58 59.500000 4181.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3216 2839.000000 131366.8300 115799.5300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 133 137.250000 6642.2500 0.0000
P 3754 3492.750000 156570.7500 156570.7500
D 0 0.000000 0.0000 0.0000
S 447 315.750000 11615.6900 11615.6900
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
17 19.250000 1284.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4351 3965.000000 176113.1800 168186.4400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3796 3004.500000 124093.0000 0.0000
P 2545 2232.000000 104203.0000 104138.2500
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 16 10.000000 370.0000 370.0000
0 0.000000 0.0000 0.0000
Other 1 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 6360 5248.750000 228762.2500 104508.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 3.750000 138.7500 0.0000
P 3603 3143.500000 127746.2500 127746.2500
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
4 3.500000 143.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3609 3150.750000 128028.5500 127746.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 32 29.750000 1100.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2286 2188.500000 85959.0000 0.0000
P 818 788.750000 32460.2500 32460.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 0.500000 18.5000 0.0000
T 0 0.000000 0.0000 0.0000
28 26.750000 1743.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3166 3034.250000 121281.7500 32460.2500