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
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 15 24.000000 1784.3400 74.3475
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 17 28.500000 1581.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 18 30.000000 2250.0000 75.0000
NUTR-97802-NUTRITIONAL EVAL, INITIAL 1 9.000000 450.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 9 38.000000 1900.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 164.2000 41.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 80 166.000000 10113.2400 60.9231
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 64 91.250000 4562.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 21 18.500000 462.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 12 17.000000 850.0000 50.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 12 14.000000 700.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 17 24.000000 1200.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 12 14.000000 700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 2 2.000000 50.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 91.000000 2275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 321 1691.500000 84575.0000 50.0000
INTR-T1013-INTERPRETER 2 12.000000 468.0000 39.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 29 72.000000 720.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 62 335.000000 23371.8400 69.7667
OCCT-97530HM-OT SESSION BY OT ASST 7 42.250000 2416.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 98 495.250000 33103.8800 66.8428
PHY-97110HM-PT SESSION BY PT ASST 4 20.500000 1171.7800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 194 1062.250000 75053.8000 70.6555
TRAV-TRAVS-Travel by mile 1173 78977.00000 34864.3400 0.4414
Subtotal (Total Children Is Unduplicated) 1283 82980.00000 266557.8400 3.2123
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Total 83146.000000 276671.0800 3.3275
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Number of Children (Unduplicated) With at Least One Service 1310
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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
2 4.000000 261.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 4.000000 261.0000 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 3533 79608.250000 246549.7500 246549.7500
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
201 3070.000000 15434.4300 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 3735 82679.750000 262096.6800 246549.7500
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 0 0.000000 0.0000 0.0000
D 1 2.000000 111.0000 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
33 35.000000 1926.6300 1032.6300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 34 37.000000 2037.6300 1032.6300
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
135 121.750000 7693.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 135 121.750000 7693.6600 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 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
13 94.500000 2460.7200 2460.7200
Other 61 209.000000 2121.3900 2121.3900
---------------------------------------------------------
Total 74 303.500000 4582.1100 4582.1100