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
Agency Filter:EXT
Payclass Filters:OTHER
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 112.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 8 8.500000 469.8500 55.2765
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 15 21.750000 1087.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 1 1.000000 25.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 9 10.000000 500.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 11 9.750000 487.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 28 224.000000 5600.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 2 14.500000 725.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 48 186.000000 9300.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 31 147.000000 1470.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 12.000000 857.2800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 4 37.000000 2116.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 12 44.500000 3030.1500 68.0933
PHY-97110HM-PT SESSION BY PT ASST 2 15.000000 857.4000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 35 215.750000 15233.1800 70.6057
TRAV-TRAVS-Travel by mile 148 8317.000000 3676.1400 0.4420
Subtotal (Total Children Is Unduplicated) 247 9258.750000 45128.0500 4.8741
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Total 9267.250000 45597.9000 4.9203
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Number of Children (Unduplicated) With at Least One Service 251
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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 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
29 234.000000 6100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 234.000000 6100.0000 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 199 4480.750000 11102.3300 11102.3300
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
125 3008.500000 8317.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 324 7489.250000 19419.7400 11102.3300
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 2 98.000000 81.8300 81.8300
116 1237.000000 11360.9900 10016.6000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 118 1335.000000 11442.8200 10098.4300
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
3 30.000000 72.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 30.000000 72.4600 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
116 111.500000 6990.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 116 111.500000 6990.5800 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
0 0.000000 0.0000 0.0000
Other 36 67.500000 1572.3000 1572.3000
---------------------------------------------------------
Total 36 67.500000 1572.3000 1572.3000