CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 Page: 1
List order: No List
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 836 952.250000 35233.2500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 752 800.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1504 5855.250000 216635.0000 36.9984
Subtotal (Total Children Is Unduplicated) 1539 7607.500000 251868.2500 33.1079
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Screening, Eval, and Assessment,Class #02
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 82.6000 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 11 11.000000 278.4100 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 3 3.000000 55.6500 18.5500
EXIT-EXIT-EXIT ASSESSMENT 3 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 60.000000 4500.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 13.500000 1012.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 777.5000 74.0476
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1725.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 69.000000 3829.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 642 1029.500000 76544.9700 74.3516
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 308 477.000000 35637.5000 74.7117
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 191 291.500000 21728.8000 74.5413
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 766 1180.000000 65217.2900 55.2689
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 309 460.000000 34761.8400 75.5692
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 26 26.000000 3395.9000 130.6115
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 13 15.000000 750.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1193 3684.000000 250549.5600 68.0102
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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 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 201 202.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 3.250000 81.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 9.000000 450.0000 50.0000
INTR-T1013-INTERPRETER 27 60.250000 2845.0000 47.2199
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 293 549.000000 5480.0000 9.9818
PHY-97110-PT SESSION BY LICENSED PT 1 4.000000 285.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 254 8010.000000 3553.4400 0.4436
Subtotal (Total Children Is Unduplicated) 433 8842.250000 12916.8900 1.4608
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Total 20133.750000 515334.7000 25.5956
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Number of Children (Unduplicated) With at Least One Service 1570
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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 305 287.500000 12311.7500 0.0000
P 45 350.500000 1811.8400 1811.8400
D 2 4.500000 223.5000 0.0000
S 1 0.250000 9.2500 0.0000
H 9 11.000000 795.7500 0.0000
T 39 233.750000 1864.2800 1864.2800
311 244.000000 8048.7500 0.0000
Other 27 41.000000 2587.5000 0.0000
---------------------------------------------------------
Total 739 1172.500000 27652.6200 3676.1200
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 41 785.000000 1822.0000 1822.0000
0 0.000000 0.0000 0.0000
Other 454 1366.000000 11142.0000 0.0000
---------------------------------------------------------
Total 495 2151.000000 12964.0000 1822.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 212 220.000000 9162.7500 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
496 497.250000 24493.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 708 717.250000 33656.5000 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 134 299.250000 11176.0000 0.0000
P 143 178.000000 9626.3400 9626.3400
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
453 526.000000 24685.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 730 1003.250000 45487.8300 9626.3400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 202 184.500000 8213.5000 0.0000
P 139 1561.500000 4658.8400 4658.3400
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
242 210.750000 4550.3000 17.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 583 1956.750000 17422.6400 4676.1400
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 5 6.000000 140.0000 140.0000
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
598 531.000000 22636.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 603 537.000000 22776.5000 140.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4 7.250000 496.2500 0.0000
P 345 476.000000 17930.7600 17930.7600
D 0 0.000000 0.0000 0.0000
S 9 16.250000 1131.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
403 310.750000 10309.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 761 810.250000 29867.2600 17930.7600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 25 42.750000 1581.7500 0.0000
P 801 1402.000000 46744.5100 46294.5100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 217 306.500000 15490.5000 0.0000
T 0 0.000000 0.0000 0.0000
30 41.500000 2741.2500 0.0000
Other 79 125.000000 9150.7500 0.0000
---------------------------------------------------------
Total 1152 1917.750000 75708.7600 46294.5100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 439 470.750000 22116.0000 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
386 458.250000 20912.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 826 929.500000 43047.0000 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 126 89.500000 3768.5000 0.0000
P 68 68.000000 2839.5700 2839.5700
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
375 307.500000 11599.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 569 465.000000 18207.8200 2839.5700
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 2.250000 83.2500 0.0000
P 189 227.500000 11247.8100 10953.0800
D 8 14.500000 804.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 28 50.500000 3488.6500 0.0000
T 78 997.500000 2875.4400 2757.4400
244 208.750000 8463.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 550 1501.000000 26963.0700 13710.5200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 9.2500
P 328 346.750000 16518.7500 16406.2500
D 0 0.000000 0.0000 0.0000
S 2 2.250000 83.2500 0.0000
H 18 103.000000 141.4000 141.4000
T 34 387.500000 722.0200 722.0200
705 848.500000 15904.4700 0.0000
Other 6 9.000000 626.2500 0.0000
---------------------------------------------------------
Total 1094 1697.250000 34005.3900 17278.9200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 333 353.000000 15478.2500 0.0000
P 275 290.750000 13517.0000 13517.0000
D 9 14.000000 594.0000 0.0000
S 12 16.000000 896.0000 896.0000
H 84 777.000000 1032.4000 1032.4000
T 82 667.250000 1096.6500 1096.6500
855 1445.750000 22132.0800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1650 3563.750000 54746.3800 16542.0500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 22 26.750000 989.7500 0.0000
P 487 673.979732 29493.6900 29493.6900
D 0 0.000000 0.0000 0.0000
S 1 0.762000 57.1500 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
556 516.758268 26708.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1071 1228.250000 57998.6500 29493.6900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 74.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.000000 130.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 13 161.000000 666.5300 666.5300
253 318.250000 13959.2500 522.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 269 483.250000 14830.2800 1188.5300