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: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 14370 43284.50000 1601070.0000 36.9895
Subtotal (Total Children Is Unduplicated) 14370 43284.50000 1601070.0000 36.9895
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 86 145.000000 10875.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 52.500000 3937.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 49 78.000000 5850.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 76 119.000000 6604.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1066 1642.000000 123135.0000 74.9909
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 442 666.500000 49987.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 253 382.000000 28625.0000 74.9346
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1162 1683.500000 93345.4500 55.4473
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 626 946.500000 70952.5000 74.9630
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
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 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 7 7.000000 357.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2302 5824.500000 399157.6800 68.5308
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 795 3879.500000 193926.0000 49.9874
OCCT-97530-OT SESSION BY LICENSED OT 21 102.500000 7279.8800 71.0232
PHY-97110-PT SESSION BY LICENSED PT 28 129.000000 9201.4800 71.3293
PHY-97110HM-PT SESSION BY PT ASST 4 27.000000 1543.3200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 71 309.500000 22110.6800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 901 4450.500000 234125.2400 52.6065
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Total 53559.500000 2234352.9200 41.7172
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Number of Children (Unduplicated) With at Least One Service 14573
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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 135 131.750000 7546.4300 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.500000 68.5000 0.0000
72 46.750000 2009.6900 0.0000
Other 6 7.500000 484.5000 0.0000
---------------------------------------------------------
Total 8496 5855.500000 242544.7200 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 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
35 23.000000 953.0000 0.0000
Other 2 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 2975 1987.500000 82341.1900 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 2864 4578.000000 179173.9600 179263.1650
D 0 0.000000 0.0000 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
227 210.500000 12765.3200 0.0000
Other 1 1.500000 55.5000 0.0000
---------------------------------------------------------
Total 3358 5195.750000 207155.5800 179263.1650
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
5297 3908.500000 163567.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5297 3908.500000 163567.5000 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 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
18 14.000000 507.0000 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 4893 3631.250000 147408.5000 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 3668 3848.250000 158776.7500 159687.2500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3695 3876.000000 159777.7000 159737.2500
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 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
15 14.000000 594.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10466 8231.250000 341488.5000 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 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
14 10.500000 388.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1960 1138.750000 43460.7500 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 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
92 86.000000 5903.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3197 2909.500000 139445.9300 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
90 91.750000 4292.7500 0.0000
Other 4 3.250000 120.2500 0.0000
---------------------------------------------------------
Total 3474 3222.250000 143599.5000 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
589 532.250000 21215.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5706 4647.500000 200450.0000 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
10 7.250000 347.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3365 2843.500000 115425.3000 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 0 0.000000 0.0000 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
3 2.000000 93.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2944 3141.500000 124986.7500 2345.0000