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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 730 806.000000 29822.0000 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 665 675.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1366 5662.250000 209376.7500 36.9777
Subtotal (Total Children Is Unduplicated) 1385 7143.250000 239198.7500 33.4860
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Screening, Eval, and Assessment,Class #02
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 126.5500 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 5 5.000000 92.7500 18.5500
EVAL-96111-DEVELOPMENTAL EVALUATION 7 20.250000 1012.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 3.500000 175.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 31 53.000000 3975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 20.000000 1500.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 63.500000 3507.7500 55.2402
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 533 819.500000 60639.7800 73.9961
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 222 334.000000 24902.5000 74.5584
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 199 311.000000 23325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 661 1028.500000 56928.5000 55.3510
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 299 423.500000 32629.6600 77.0476
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 24 24.000000 1840.9900 76.7079
SCREEN-T1023-SCREENING 9 11.000000 550.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1048 3166.750000 214580.9800 67.7606
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 3.000000 150.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 163 182.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 42.250000 2112.5000 50.0000
INTR-T1013-INTERPRETER 44 93.500000 4442.1400 47.5095
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 226 461.000000 4610.0000 10.0000
PHY-97110-PT SESSION BY LICENSED PT 1 11.000000 785.8400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 1.500000 85.7400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 3.750000 267.9000 71.4400
TRAV-TRAVS-Travel by mile 223 6917.000000 3063.4100 0.4429
Subtotal (Total Children Is Unduplicated) 387 7717.750000 15617.5300 2.0236
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Total 18027.750000 469397.2600 26.0375
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Number of Children (Unduplicated) With at Least One Service 1418
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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 352 280.250000 11117.5000 0.0000
P 127 800.500000 6225.8100 6225.8100
D 9 20.000000 231.1500 0.0000
S 1 1.500000 112.5000 0.0000
H 12 17.000000 1226.2500 0.0000
T 5 14.500000 251.5500 168.3000
382 293.500000 9762.7500 0.0000
Other 38 49.000000 3090.0000 0.0000
---------------------------------------------------------
Total 926 1476.250000 32017.5100 6394.1100
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 34 526.500000 1358.1600 1358.1600
1 77.000000 34.2700 0.0000
Other 389 1499.250000 10228.1700 0.0000
---------------------------------------------------------
Total 424 2102.750000 11620.6000 1358.1600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 349 370.250000 16539.5000 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
350 327.750000 14225.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 699 698.000000 30764.6400 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 8 25.250000 934.2500 0.0000
P 277 499.000000 21800.5000 21846.8200
D 1 0.500000 18.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 15.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
460 518.750000 23843.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 750 1058.500000 47347.2000 21846.8200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 184 165.750000 7462.7500 0.0000
P 75 691.500000 2567.4700 2567.4700
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
189 119.750000 3172.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 451 979.500000 13295.4700 2567.4700
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 2 4.000000 247.0000 247.0000
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
353 318.250000 13567.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 355 322.250000 13814.0000 247.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 112.5000 0.0000
P 332 395.750000 17039.2500 17039.2500
D 7 9.000000 370.0000 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
454 362.750000 11896.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 794 769.000000 29418.0000 17039.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 150.0000 0.0000
P 633 1372.250000 39573.1100 39573.1120
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 23.000000 1559.2500 0.0000
T 0 0.000000 0.0000 0.0000
51 74.750000 3723.2500 0.0000
Other 84 128.000000 9424.5000 0.0000
---------------------------------------------------------
Total 784 1601.500000 54542.6100 39573.1120
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 495 528.000000 24436.7500 0.0000
P 7 22.000000 300.0000 300.0000
D 3 2.750000 101.7500 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
471 547.000000 23400.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 976 1099.750000 48239.2500 300.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 154 117.250000 4880.2500 0.0000
P 44 178.000000 1648.8000 1648.8000
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
304 227.750000 8294.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 502 523.000000 14823.8000 1648.8000
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 246 297.500000 14060.1900 13733.4200
D 3 5.500000 305.2500 0.0000
S 4 8.000000 561.0000 0.0000
H 4 7.500000 494.2500 0.0000
T 85 1033.000000 3241.9500 3092.9500
256 255.250000 10091.6600 9.3500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 598 1606.750000 28754.3000 16835.7200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 44 31.750000 1174.7500 0.0000
P 239 265.750000 12474.5000 12362.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 48 371.000000 533.2300 533.2300
T 22 184.000000 510.6300 510.6300
616 570.000000 15023.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 969 1422.500000 29716.1700 13405.8600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 324 293.250000 12127.2500 0.0000
P 64 70.250000 3843.0000 3843.0000
D 2 1.750000 64.7500 0.0000
S 22 31.000000 2249.0000 2249.0000
H 74 589.750000 1416.7100 1416.7100
T 71 568.000000 1551.9800 1551.9800
863 1276.500000 23715.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1420 2830.500000 44968.1500 9060.6900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 4.500000 166.5000 0.0000
P 543 727.802500 31470.5100 31396.5100
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
586 550.947500 27065.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1132 1283.250000 58702.3100 31396.5100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 69 94.500000 4117.5000 0.0000
P 2 1.500000 112.5000 112.5000
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 6 8.000000 301.0000 301.0000
114 150.250000 6842.2500 261.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 191 254.250000 11373.2500 674.5000