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
Agency Filter:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 11128 12426.00000 459551.2500 36.9830
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7833 7951.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21684 67604.75000 2500272.5000 36.9837
Subtotal (Total Children Is Unduplicated) 22690 87981.75000 2959823.7500 33.6413
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 5.000000 242.5000 48.5000
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 30 30.000000 759.3000 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 30 30.000000 556.5000 18.5500
EVAL-96111-DEVELOPMENTAL EVALUATION 80 93.250000 4662.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 581 916.000000 45800.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 136 236.500000 17737.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 65 94.500000 7087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 28.000000 2100.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 88 138.000000 10944.2100 79.3059
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 130 211.000000 11710.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1859 2972.000000 221830.0700 74.6400
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 771 1226.500000 91668.6100 74.7400
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 446 689.000000 51363.7900 74.5483
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2011 3097.500000 171107.4800 55.2405
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1048 1604.500000 121689.3900 75.8426
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 121 122.000000 11371.2600 93.2070
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 507.0000 507.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 21 21.000000 1114.0300 53.0490
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 49 62.000000 3100.0000 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 20 20.000000 1021.0000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 4463 11611.75000 777081.3400 66.9220
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 267 304.750000 15237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1068 1489.750000 74281.2500 49.8616
CONIP-CONIP-CONSULT, ITDS PHONE 52 28.250000 706.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 67 82.750000 4137.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 86 103.000000 5150.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 241 294.250000 14712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 4 3.250000 81.2500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 6.000000 439.9200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1834 4266.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1139 5804.500000 290201.0000 49.9959
INTR-T1013-INTERPRETER 277 559.250000 27962.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1659 7808.000000 78060.0000 9.9974
OCCT-97530-OT SESSION BY LICENSED OT 39 173.500000 12229.4000 70.4865
PHY-97110-PT SESSION BY LICENSED PT 62 279.250000 19935.3400 71.3889
PHY-97110HM-PT SESSION BY PT ASST 6 30.000000 1714.8000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 211 1135.500000 80481.5600 70.8776
SPL-92508-GROUP SPL SESSION PER CHILD 3 6.000000 83.2800 13.8800
TRAV-TRAVS-Travel by mile 577 38941.00000 17333.0500 0.4451
Subtotal (Total Children Is Unduplicated) 3221 61326.75000 643028.3500 10.4853
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Total 160920.250000 4379933.4400 27.2180
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Number of Children (Unduplicated) With at Least One Service 23046
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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 206 249.000000 15356.9500 15356.9500
D 91 97.000000 6905.8600 0.0000
S 137 132.750000 7583.4300 0.0000
H 399 437.750000 30045.8600 0.0000
T 8 7.500000 497.1400 0.0000
6003 3914.500000 126460.8900 0.0000
Other 7 8.500000 534.5000 0.0000
---------------------------------------------------------
Total 14835 10169.000000 397557.4200 15356.9500
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 5098 15473.500000 112511.4300 0.0000
---------------------------------------------------------
Total 5098 15473.500000 112511.4300 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
5770 3748.750000 128250.3800 0.0000
Other 2 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 8710 5713.250000 209638.5700 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 265 404.250000 15105.3000 0.0000
P 2885 4598.000000 183314.1500 183403.3550
D 7 5.250000 194.2500 0.0000
S 1 1.500000 55.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3787 3704.500000 162569.1100 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 6946 8715.000000 361293.8100 183403.3550
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 140 543.250000 9935.3600 9935.3600
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
2734 1555.000000 45223.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5553 3816.750000 123318.3600 9935.3600
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
13591 8901.750000 331783.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13591 8901.750000 331783.5000 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 235 175.250000 6747.2500 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
6214 3831.750000 115083.5000 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 11323 7624.000000 268723.0000 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 13877 12541.750000 465366.7500 466347.8500
D 12 17.000000 1214.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 47 88.500000 6044.1300 0.0000
T 0 0.000000 0.0000 0.0000
539 537.750000 21786.8200 74.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14502 13212.750000 495413.2900 466472.2500
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 86 54.000000 1998.0000 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
7782 6633.500000 246696.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18319 14904.750000 589589.0000 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1927 1120.000000 42767.0000 0.0000
P 3 1.000000 37.0000 0.0000
D 14 6.500000 240.5000 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
3967 2534.750000 86909.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5914 3663.250000 129990.9000 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 23 15.750000 557.0000 0.0000
P 3062 2830.750000 131097.8500 128804.9100
D 70 78.000000 4374.3700 0.0000
S 18 32.500000 2266.5000 0.0000
H 76 94.750000 6272.6400 0.0000
T 3320 28228.750000 72092.3500 60936.2700
3232 2088.000000 62599.6400 27.1200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9801 33368.500000 279260.3500 189768.3000
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 3138 2994.228600 135510.1800 133235.7800
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
10908 8388.271400 161300.7600 0.0000
Other 65 70.750000 3799.2500 0.0000
---------------------------------------------------------
Total 14417 11656.500000 308130.4400 133235.7800
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 36 26.750000 1067.2500 0.0000
S 207 227.500000 12807.5000 12798.2500
H 95 90.250000 3430.2500 3080.2500
T 0 0.000000 0.0000 0.0000
11289 8578.500000 165555.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16447 12726.250000 346148.2700 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 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
4079 2463.250000 82987.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7435 5301.500000 198215.8500 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 45 40.500000 2345.0000 2345.0000
D 10 12.500000 519.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 3.000000 166.5000 0.0000
T 0 0.000000 0.0000 0.0000
2545 2521.500000 102946.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5496 5673.500000 228359.2500 2345.0000