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:GR
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 500 2053.500000 75925.0000 36.9735
Subtotal (Total Children Is Unduplicated) 1181 3534.500000 105747.0000 29.9185
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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 6 12.250000 612.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 3 3.500000 175.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 13.000000 975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 1.000000 75.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 21.000000 1165.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 130 174.622232 13009.1700 74.4989
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 49 66.509200 4988.1900 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 82.000000 6150.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 206 267.480000 14789.4200 55.2917
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 88.500000 6637.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 10 10.000000 535.5000 53.5500
SCREEN-T1023-SCREENING 1 2.000000 100.0000 50.0000
Subtotal (Total Children Is Unduplicated) 346 767.361432 50594.5800 65.9332
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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 162 181.750000 0.0000 0.0000
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
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) 383 7673.000000 13419.2900 1.7489
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Total 11974.861432 169760.8700 14.1764
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Number of Children (Unduplicated) With at Least One Service 1261
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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 0 0.000000 0.0000 0.0000
P 94 748.500000 2926.3900 2926.3900
D 7 17.000000 45.1500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 11.000000 85.0500 85.0500
376 287.750000 9389.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 480 1064.250000 12445.8400 3011.4400
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 33 524.500000 1208.1600 1208.1600
1 77.000000 34.2700 0.0000
Other 207 1333.250000 2632.6700 0.0000
---------------------------------------------------------
Total 241 1934.750000 3875.1000 1208.1600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
348 325.750000 14125.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 348 325.750000 14125.1400 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 0 0.000000 0.0000 0.0000
P 4 15.000000 150.0000 150.0000
D 1 0.500000 18.5000 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
390 452.250000 19293.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 395 467.750000 19461.8000 150.0000
Center 05
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 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 264 811.250000 5740.2200 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
207 149.250000 4836.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 209 153.250000 5083.5000 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 0 0.000000 0.0000 0.0000
P 21 32.500000 575.2500 575.2500
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
451 358.250000 11729.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 479 399.750000 12675.0000 575.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 384 947.000000 18027.8600 18027.8600
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
6 8.500000 472.0000 0.0000
Other 2 3.500000 223.5000 0.0000
---------------------------------------------------------
Total 392 959.000000 18723.3600 18027.8600
Center 10
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 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
406 410.500000 14528.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 416 435.250000 14930.0000 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 0 0.000000 0.0000 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
281 202.500000 6543.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 325 380.500000 8192.3000 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 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 71 1006.500000 1663.8400 1622.8400
215 179.750000 4995.8500 9.3500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 286 1186.250000 6659.6900 1632.1900
Center 53
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 48 371.000000 533.2300 533.2300
T 22 184.000000 510.6300 510.6300
559 484.500000 9651.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 629 1039.500000 10695.1700 1043.8600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 1.750000 64.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 69 585.000000 1145.9600 1145.9600
T 68 562.500000 1188.2300 1188.2300
699 1058.480000 11812.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 838 2207.730000 14211.0700 2334.1900
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 39 113.052500 3373.5100 3373.5100
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
472 348.578932 13078.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 511 461.631432 16451.9300 3373.5100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 4 4.000000 40.0000 40.0000
110 144.250000 6450.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 114 148.250000 6490.7500 40.0000