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
Payclass Filters:GR
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 11126 12419.50000 459310.7500 36.9830
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7833 7949.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7661 23839.50000 881396.2500 36.9721
Subtotal (Total Children Is Unduplicated) 17411 44208.50000 1340707.0000 30.3269
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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 79 92.250000 4612.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 568 892.000000 44600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 34 47.500000 3562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 19.500000 1462.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 21 24.500000 1837.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 42 51.000000 2830.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 408 578.710000 43403.2500 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 146 209.000000 15675.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 79 117.500000 8812.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 598 738.000000 40959.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 249 326.500000 24487.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 56 56.000000 2998.8000 53.5500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 9 9.000000 239.4900 26.6100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 19 29.000000 1450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1667 3275.460000 199701.9400 60.9691
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 265 302.250000 15112.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 4 2.500000 62.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1066 1485.000000 74043.7500 49.8611
CONIP-CONIP-CONSULT, ITDS PHONE 52 28.250000 706.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 66 81.750000 4087.5000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 83 96.500000 4825.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 1.750000 43.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 240 292.250000 14612.5000 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 1820 4217.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 5.000000 125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 201 891.621400 44581.0700 50.0000
INTR-T1013-INTERPRETER 277 559.250000 27962.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1659 7804.000000 78020.0000 9.9974
OCCT-97530-OT SESSION BY LICENSED OT 4 9.000000 642.9600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 39.000000 2786.1600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 2.000000 114.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 256.000000 18263.6400 71.3423
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.000000 69.4000 13.8800
TRAV-TRAVS-Travel by mile 577 38898.00000 17313.9100 0.4451
Subtotal (Total Children Is Unduplicated) 3030 54985.62140 303893.8800 5.5268
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Total 102469.581400 1844302.8200 17.9985
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Number of Children (Unduplicated) With at Least One Service 18269
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 1.000000 37.0000 0.0000
H 4 4.500000 326.8200 0.0000
T 0 0.000000 0.0000 0.0000
5873 3795.500000 119993.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5879 3801.000000 120357.5100 0.0000
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 3403 14222.250000 58007.1800 0.0000
---------------------------------------------------------
Total 3403 14222.250000 58007.1800 0.0000
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
5724 3712.750000 126389.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5724 3712.750000 126389.0900 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 1 0.500000 18.5000 18.5000
D 7 5.250000 194.2500 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
3463 3390.500000 137162.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3471 3396.250000 137375.2900 18.5000
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 135 529.500000 9016.3300 9016.3300
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
2732 1554.000000 45186.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2867 2083.500000 54202.5800 9016.3300
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
8030 4584.750000 139821.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8030 4584.750000 139821.0000 0.0000
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 0 0.000000 0.0000 0.0000
D 234 175.000000 6738.0000 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
6196 3817.750000 114576.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6430 3992.750000 121314.5000 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 9771 8230.500000 281425.8300 281425.8300
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
35 27.750000 1008.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9806 8258.250000 282434.0800 281425.8300
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 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
7347 5693.000000 182182.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7433 5747.000000 184180.2500 0.0000
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 0 0.000000 0.0000 0.0000
D 1 0.250000 9.2500 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
3918 2483.000000 83783.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3919 2483.250000 83792.3800 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 0 0.000000 0.0000 0.0000
P 6 54.500000 207.2500 207.2500
D 3 2.500000 125.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2944 27811.250000 47304.2700 44008.5700
2956 1741.500000 42841.8700 27.1200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5909 29609.750000 90478.3900 44242.9400
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
10379 7827.371400 132643.7100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10379 7827.371400 132643.7100 0.0000
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 34 25.500000 1008.0000 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
10468 7793.000000 130145.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10502 7818.500000 131153.0600 0.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
4029 2400.210000 78781.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4029 2400.210000 78781.3000 0.0000
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 10 12.500000 519.0000 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
2542 2519.500000 102853.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2552 2532.000000 103372.5000 0.0000