CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 13452 41747.00000 1544219.5000 36.9900
Subtotal (Total Children Is Unduplicated) 13452 41747.00000 1544219.5000 36.9900
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 124.500000 9337.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 38 52.000000 3900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 18.000000 1350.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 37 57.000000 4275.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 64 100.500000 5577.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1027 1584.000000 118690.2900 74.9307
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 397 585.500000 43888.1500 74.9584
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 214 328.500000 24612.5000 74.9239
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1208 1771.000000 98201.7000 55.4499
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 690 1053.500000 78977.5000 74.9668
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.000000 535.5000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 26.6100 26.6100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 33 34.000000 1700.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2389 5730.500000 391634.0500 68.3420
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 701 3422.500000 171076.0000 49.9857
OCCT-97530-OT SESSION BY LICENSED OT 18 53.000000 3252.0800 61.3600
PHY-97110-PT SESSION BY LICENSED PT 26 90.000000 6429.6000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 9.000000 514.4400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 56 181.500000 12720.6000 70.0860
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 791 3762.000000 194098.2400 51.5944
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Total 51239.500000 2129951.7900 41.5686
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Number of Children (Unduplicated) With at Least One Service 13696
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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 8338 5603.250000 221327.2900 0.0000
P 224 273.000000 17102.7000 17102.7000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8562 5876.250000 238429.9900 17102.7000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 25.000000 981.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3251 2309.250000 96927.6900 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 3287 2334.250000 97909.1900 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 15.000000 555.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 303 459.750000 17158.8000 0.0000
P 3307 5185.250000 203697.5600 203833.0850
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 3627 5660.000000 221411.3600 203833.0850
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2864 1885.250000 75659.5000 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 2867 1887.750000 75752.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.250000 159.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 35 30.500000 1489.5000 0.0000
P 5141 3938.000000 161147.0000 161147.0000
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 5178 3970.750000 162795.7500 161147.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 28 29.750000 1150.9500 50.0000
P 3861 4189.000000 174916.2500 175826.7520
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 3889 4218.750000 176067.2000 175876.7520
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 10938 8742.000000 365211.0000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10946 8745.250000 365331.2500 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 1.500000 62.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2081 1237.250000 47647.2500 0.0000
P 7 18.000000 263.5700 171.0500
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 2092 1256.750000 47972.8200 171.0500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 15.750000 557.0000 0.0000
P 3262 3023.000000 141423.7900 140259.1100
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 3285 3038.750000 141980.7900 140259.1100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 348 233.000000 8621.0000 0.0000
P 3312 3188.250000 144028.2500 144028.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3662 3423.250000 152723.2500 144028.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 62 61.250000 2507.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4107 3115.750000 128218.0000 0.0000
P 1039 989.750000 48532.7500 48505.0000
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 5208 4166.750000 179258.0000 48505.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 6 7.750000 286.7500 0.0000
P 3842 3419.750000 141004.7500 140927.7500
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 3848 3427.500000 141291.5000 140927.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2961 3190.500000 126499.7500 0.0000
P 48 43.000000 2528.9400 2528.9400
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 3009 3233.500000 129028.6900 2528.9400