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
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 14479 43464.00000 1607711.5000 36.9895
Subtotal (Total Children Is Unduplicated) 14479 43464.00000 1607711.5000 36.9895
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 97 163.000000 12225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 52 78.500000 5812.5000 74.0446
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 30.500000 2287.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 67 105.500000 7912.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 125 207.500000 11417.7500 55.0253
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1254 1937.500000 145297.5000 74.9923
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 520 806.500000 60487.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 360 569.000000 42650.0000 74.9561
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1494 2252.000000 124841.7000 55.4359
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 776 1178.000000 88276.0000 74.9372
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 43 44.000000 2356.2000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 8 8.000000 212.8800 26.6100
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 14.000000 714.7000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 26 26.000000 1327.3000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 59 66.000000 3369.3000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 10 10.000000 510.5000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 65 65.000000 3318.2500 51.0500
SCREEN-T1023-SCREENING 28 29.000000 1450.0000 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 73 73.000000 3726.6500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 2681 7676.000000 518850.8800 67.5939
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 7.000000 513.2400 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 16.000000 400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5419 41777.75000 2088391.5000 49.9881
OCCT-97530-OT SESSION BY LICENSED OT 316 1708.750000 121524.6200 71.1190
OCCT-97530HM-OT SESSION BY OT ASST 166 991.750000 56728.1000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 283 1757.000000 125505.8000 71.4319
PHY-97110HM-PT SESSION BY PT ASST 109 797.500000 45585.1000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 574 3716.000000 264736.2000 71.2422
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 34.500000 1973.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 11 32.000000 444.1600 13.8800
Subtotal (Total Children Is Unduplicated) 6224 50838.25000 2705802.1200 53.2237
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Total 101978.250000 4832364.5000 47.3862
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Number of Children (Unduplicated) With at Least One Service 15625
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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 7984 5322.000000 210172.7900 0.0000
P 207 250.000000 15406.9500 15406.9500
D 194 197.000000 12458.4100 0.0000
S 135 131.750000 7546.4300 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.500000 68.5000 0.0000
74 49.750000 2176.1900 0.0000
Other 239 315.000000 19265.7000 0.0000
---------------------------------------------------------
Total 8835 6267.000000 267094.9700 15406.9500
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 1695 1251.250000 54504.2500 0.0000
---------------------------------------------------------
Total 1695 1251.250000 54504.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 25.000000 981.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2902 1939.000000 80388.1900 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
36 24.000000 1003.0000 0.0000
Other 2 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 2976 1988.500000 82391.1900 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 295 434.500000 16224.5500 0.0000
P 3045 4712.250000 184141.2100 184230.4150
D 0 0.000000 0.0000 0.0000
S 1 1.500000 55.5000 0.0000
H 2281 9420.000000 483194.8300 0.0000
T 0 0.000000 0.0000 0.0000
369 604.750000 40665.4700 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 6009 15189.500000 724892.0600 184230.4150
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2679 1718.500000 68159.7500 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
2 1.000000 37.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2681 1719.500000 68196.7500 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
5348 3996.500000 169306.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5348 3996.500000 169306.6300 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 34 29.000000 1377.0000 0.0000
P 4833 3579.750000 145058.0000 145058.0000
D 1 0.250000 9.2500 0.0000
S 3 2.750000 177.7500 0.0000
H 1 2.250000 83.2500 0.0000
T 0 0.000000 0.0000 0.0000
19 23.000000 957.0000 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 4894 3640.250000 147858.5000 145058.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 27 27.750000 1000.9500 50.0000
P 3669 3849.750000 158889.2500 159799.7500
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
2061 6479.500000 354237.7100 0.0000
Other 150 242.000000 17750.2500 0.0000
---------------------------------------------------------
Total 5907 10599.000000 531878.1600 159849.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 10443 8214.000000 340774.2500 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
3304 11613.500000 595127.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13755 19830.750000 936022.1200 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 1927 1120.000000 42767.0000 0.0000
P 7 18.000000 263.5700 171.0500
D 13 6.250000 231.2500 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
1095 3121.500000 186934.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3046 4267.250000 230258.7600 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 3021 2735.500000 128035.6000 126870.9200
D 17 16.250000 1146.6200 0.0000
S 18 32.500000 2266.5000 0.0000
H 26 23.500000 1537.0500 0.0000
T 0 0.000000 0.0000 0.0000
691 1478.750000 87431.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3796 4302.250000 220974.1200 126870.9200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 304 201.250000 7446.2500 0.0000
P 3074 2924.000000 131666.2500 131666.2500
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
1807 1898.500000 97497.1800 0.0000
Other 4 3.250000 120.2500 0.0000
---------------------------------------------------------
Total 5191 5029.000000 236803.9300 131666.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 62 61.250000 2507.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3783 2822.500000 116090.7500 0.0000
P 975 919.500000 44689.7500 44662.0000
D 2 1.250000 59.2500 0.0000
S 207 227.500000 12807.5000 12798.2500
H 88 83.250000 3080.2500 3080.2500
T 0 0.000000 0.0000 0.0000
4241 4306.250000 216641.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9358 8421.500000 395876.3500 60540.5000
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 3.250000 120.2500 0.0000
P 3352 2833.000000 114957.7500 114954.7500
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
4148 3922.750000 240011.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7503 6759.000000 355089.9500 114954.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2892 3096.000000 122382.2500 0.0000
P 46 41.500000 2416.4400 2416.4400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 3.000000 166.5000 0.0000
T 1 4.000000 200.0000 200.0000
1693 5572.500000 286051.5700 285901.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4636 8717.000000 411216.7600 288517.8900