CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 Page: 1
List order: No List
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 15004 46005.50000 1701347.5000 36.9814
Subtotal (Total Children Is Unduplicated) 15004 46005.50000 1701347.5000 36.9814
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 106 174.000000 13050.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 69 117.500000 8812.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 34.000000 2550.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 85 130.500000 9787.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 140 229.000000 12709.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1137 1680.000000 126000.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 554 798.500000 59887.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 367 563.000000 42187.5000 74.9334
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1529 2324.000000 128954.2500 55.4881
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 814 1210.500000 90675.0000 74.9071
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 25 25.000000 1338.7500 53.5500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 75.7200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 53.2200 26.6100
OCTF-97168-OT RE-EVAL EST PLAN CARE 6 6.000000 306.3000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 28 32.000000 1633.6000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 7 7.000000 357.3500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 33 34.000000 1735.7000 51.0500
SCREEN-T1023-SCREENING 73 73.000000 3650.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 32.000000 1633.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 10 10.000000 510.5000 51.0500
Subtotal (Total Children Is Unduplicated) 2645 7496.000000 506572.1400 67.5790
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 782.0400 782.0400
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 10.000000 733.2000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 19 94.500000 2362.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5875 44750.00000 2237277.0000 49.9950
OCCT-97530-OT SESSION BY LICENSED OT 307 1682.500000 120140.8400 71.4061
OCCT-97530HM-OT SESSION BY OT ASST 144 749.250000 42803.9000 57.1290
PHY-97110-PT SESSION BY LICENSED PT 299 1523.250000 108721.8000 71.3749
PHY-97110HM-PT SESSION BY PT ASST 71 403.250000 23049.7700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 581 3452.000000 246570.1000 71.4282
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 8.000000 457.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 6 20.750000 288.0100 13.8800
Subtotal (Total Children Is Unduplicated) 6672 52694.50000 2783186.7600 52.8174
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Total 106196.000000 4991106.4000 46.9990
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Number of Children (Unduplicated) With at Least One Service 16041
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 87 77.500000 3487.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 8195 5565.000000 220160.8000 0.0000
P 17 17.000000 1860.7600 1860.7600
D 73 72.000000 4011.2400 0.0000
S 539 425.500000 15743.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 13 12.750000 597.1900 421.4400
35 20.500000 815.5000 0.0000
Other 61 94.000000 6300.7500 0.0000
---------------------------------------------------------
Total 9020 6284.250000 252977.1600 2282.2000
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 1830 1363.750000 59689.2500 0.0000
---------------------------------------------------------
Total 1830 1363.750000 59689.2500 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 1441 853.500000 32863.2500 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
1184 704.750000 26253.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2625 1558.250000 59116.4400 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.750000 101.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3043 4586.000000 172648.2500 0.0000
P 1154 1489.250000 64927.0600 64944.6300
D 0 0.000000 0.0000 0.0000
S 2 1.750000 64.7500 0.0000
H 2729 11079.500000 560999.0700 387.8600
T 0 0.000000 0.0000 0.0000
400 559.250000 36888.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7329 17718.500000 835629.8100 65332.4900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.000000 222.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2598 1706.250000 67848.7500 0.0000
P 1 1.000000 25.0000 25.0000
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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2610 1713.500000 68105.0000 25.0000
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
5500 4064.250000 171002.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5500 4064.250000 171002.0300 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 22 18.250000 675.2500 0.0000
P 5356 4080.500000 165935.7500 165926.5000
D 0 0.000000 0.0000 0.0000
S 2 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.000000 37.0000 0.0000
87 91.750000 4491.7500 0.0000
Other 3 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 5472 4195.250000 171278.5000 165926.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.000000 225.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 54 59.000000 2992.7500 0.0000
P 4285 4247.500000 173187.0000 175759.5690
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
2152 6822.500000 379350.3800 0.0000
Other 143 213.000000 15692.2500 0.0000
---------------------------------------------------------
Total 6636 11345.000000 571447.3800 175759.5690
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 4.500000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 10031 7731.750000 323570.2500 0.0000
P 1 0.250000 9.2500 0.0000
D 0 0.000000 0.0000 0.0000
S 3 3.500000 224.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3304 11557.500000 592132.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13349 19297.500000 916103.4200 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 2341 1454.000000 56921.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 32 15.000000 573.5000 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
855 2606.750000 153425.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3228 4075.750000 210920.4100 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 353 361.500000 17895.2500 114.7500
P 2900 2537.500000 115837.4800 115607.0000
D 8 6.000000 420.0300 0.0000
S 5 7.000000 450.0000 0.0000
H 148 129.750000 8956.1500 0.0000
T 0 0.000000 0.0000 0.0000
733 1499.250000 89758.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4147 4541.000000 233316.9100 115721.7500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 427 347.500000 14617.5000 1387.5000
P 3865 3693.250000 166505.0000 166449.5000
D 0 0.000000 0.0000 0.0000
S 3 2.500000 118.5000 18.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2162 2191.250000 111837.7000 0.0000
Other 4 2.500000 93.5000 0.0000
---------------------------------------------------------
Total 6462 6237.500000 293190.7000 167855.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2843 2283.750000 98674.0000 0.0000
P 26 23.500000 1176.5000 1158.0000
D 0 0.000000 0.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 11 9.000000 333.0000 333.0000
6719 6177.000000 295775.5800 0.0000
Other 3 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 9604 8496.250000 396070.0800 1491.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 6.000000 374.0000 0.0000
P 3563 3076.250000 124650.7500 124539.9300
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
3956 3726.750000 229096.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7523 6809.000000 354121.3200 124539.9300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1301 1268.750000 48950.0000 0.0000
P 2029 1962.500000 82281.0000 82281.0000
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
1507 5219.000000 265204.9900 264454.7400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4838 8452.750000 396528.4900 346735.7400