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:TPIN
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 3 0.750000 27.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8 4.750000 450.0000 94.7368
TCM-T1017TL-TARGETED CASE MANAGEMENT 20 48.500000 1794.5000 37.0000
Subtotal (Total Children Is Unduplicated) 31 54.000000 2272.2500 42.0787
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 18 30.857000 477.9700 15.4898
EXIT-EXIT-EXIT ASSESSMENT 1 1.000000 50.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 23 42.238000 3205.3500 75.8878
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 18.000000 1350.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 37.000000 2775.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 17 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 285 510.123601 38131.9300 74.7504
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 106 180.500000 13500.0000 74.7922
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 51 84.000000 6231.9200 74.1895
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 302 541.000000 30025.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 209 304.000000 23701.8700 77.9667
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 3552.8300 296.0692
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 3 3.000000 579.0000 193.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 700.0000 700.0000
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 655 1823.718601 127524.6700 69.9256
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 1.000000 73.3200 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 211 912.925000 45663.7500 50.0192
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 104.750000 7922.6000 75.6334
PHY-97110-PT SESSION BY LICENSED PT 36 459.500000 24946.4200 54.2904
PHY-97110HM-PT SESSION BY PT ASST 1 5.000000 285.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 304.750000 58809.1000 192.9749
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 600.0000 600.0000
Subtotal (Total Children Is Unduplicated) 330 1794.925000 138485.9900 77.1542
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Total 3672.643601 268282.9100 73.0490
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Number of Children (Unduplicated) With at Least One Service 960
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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 100.0000 0.0000
S 110 120.000000 8458.2000 0.0000
H 113 138.250000 9895.6000 0.0000
T 0 0.000000 0.0000 0.0000
25 31.500000 2084.9000 0.0000
Other 1 1.000000 71.4400 0.0000
---------------------------------------------------------
Total 251 292.750000 20610.1400 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 127 125.250000 43599.7500 0.0000
T 0 0.000000 0.0000 0.0000
43 319.000000 17591.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 170 444.250000 61191.1900 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 6 6.000000 1485.7000 1485.7000
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
91 96.500000 10110.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 97 102.500000 11596.2000 1485.7000
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 1 1.000000 71.4400 71.4400
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 1 1.000000 71.4400 71.4400
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
219 324.500000 21656.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 219 324.500000 21656.2500 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 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
11 11.000000 407.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11 11.000000 407.0000 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 74 74.500000 5298.3700 5456.7700
D 6 9.000000 599.6300 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
163 219.500000 14664.0300 71.4600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 243 303.000000 20562.0300 5528.2300
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
341 684.000000 46902.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 341 684.000000 46902.7500 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 102 121.750000 8194.5400 5602.9300
D 61 71.500000 4417.0400 0.0000
S 0 0.000000 0.0000 0.0000
H 62 66.000000 4261.9600 0.0000
T 27 28.000000 1518.2000 1070.0000
268 330.500000 19368.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 520 617.750000 37759.8700 6672.9300
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 29 29.675000 1410.2500 1845.2500
D 3 3.000000 150.0000 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
487 513.750000 26505.0700 637.5000
Other 18 17.250000 859.2500 0.0000
---------------------------------------------------------
Total 537 563.675000 28924.5700 2482.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4 4.000000 200.0000 270.0000
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
275 301.250000 16886.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 279 305.250000 17086.2500 270.0000
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 4 7.095000 485.7000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
11 10.623601 759.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16 19.718601 1394.9700 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 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 3.250000 120.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 3.250000 120.2500 0.0000