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: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 14910 45865.00000 1696149.0000 36.9813
Subtotal (Total Children Is Unduplicated) 14910 45865.00000 1696149.0000 36.9813
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 97 158.500000 11887.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 96.500000 7237.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 16.000000 1200.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 75 117.500000 8812.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 103 158.500000 8796.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1026 1505.000000 112875.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 491 690.000000 51750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 233 331.500000 24825.0000 74.8869
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1353 2018.000000 111971.2500 55.4862
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 670 981.500000 73537.5000 74.9236
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
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 73 73.000000 3650.0000 50.0000
Subtotal (Total Children Is Unduplicated) 2447 6175.000000 418061.7400 67.7023
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 10.000000 733.2000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 28.000000 700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1032 4845.250000 242262.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 20 54.750000 3911.3400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 30 65.500000 4679.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 33.000000 1886.2800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 145.750000 10412.3800 71.4400
Subtotal (Total Children Is Unduplicated) 1115 5182.250000 264585.0200 51.0560
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Total 57222.250000 2378795.7600 41.5712
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Number of Children (Unduplicated) With at Least One Service 15065
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 539 425.500000 15743.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 5 4.750000 175.7500 0.0000
34 19.000000 703.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8860 6091.750000 240270.4700 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 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
1177 697.750000 25881.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2618 1551.250000 58745.0000 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 2995 4548.500000 171260.7500 0.0000
P 1030 1389.750000 61245.5600 61263.1300
D 0 0.000000 0.0000 0.0000
S 2 1.750000 64.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
253 241.250000 14637.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4281 6184.000000 247309.9400 61263.1300
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 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
1 0.250000 9.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2609 1712.500000 68080.0000 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
5094 3651.250000 148860.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5094 3651.250000 148860.5000 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
75 58.750000 2841.7500 0.0000
Other 3 3.000000 111.0000 0.0000
---------------------------------------------------------
Total 5460 4162.250000 169628.5000 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
1 1.500000 112.5000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 4343 4313.000000 176667.2500 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
21 17.250000 685.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10066 7757.250000 324655.5000 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
9 3.750000 138.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2382 1472.750000 57634.0000 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 4 6.000000 400.0000 0.0000
H 148 129.750000 8956.1500 0.0000
T 0 0.000000 0.0000 0.0000
90 66.000000 4545.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3503 3106.750000 148054.9000 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
209 157.500000 7074.7000 0.0000
Other 4 2.500000 93.5000 0.0000
---------------------------------------------------------
Total 4509 4203.750000 188427.7000 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
3559 2965.000000 131950.2500 0.0000
Other 3 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 6444 5284.250000 232244.7500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3567 3082.250000 125024.7500 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
10 8.250000 570.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3341 3242.000000 131893.7500 82281.0000