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: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 11651 13559.25000 501526.7500 36.9878
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8252 8234.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21752 67433.50000 2494226.0000 36.9879
Subtotal (Total Children Is Unduplicated) 22848 89227.25000 2995752.7500 33.5744
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 11 11.000000 533.5000 48.5000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 14 14.000000 115.6400 8.2600
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 28 28.000000 708.6800 25.3100
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 24 24.000000 445.2000 18.5500
EVAL-96111-DEVELOPMENTAL EVALUATION 110 116.500000 5825.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 456 738.500000 36850.0000 49.8984
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 120 206.500000 15487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 65 96.000000 7200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 12 19.000000 1425.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 99 183.500000 13762.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 146 223.500000 12353.2500 55.2718
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1928 3242.500000 241824.9700 74.5798
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 848 1379.000000 102844.7400 74.5792
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 438 725.500000 54017.5300 74.4556
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2179 3529.500000 195463.5700 55.3800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 985 1594.500000 119383.8800 74.8723
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 106 106.000000 10434.8500 98.4420
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 11 11.000000 832.9200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 13 13.000000 678.7100 52.2085
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 41.4600 41.4600
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 22 22.000000 1075.9000 48.9045
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 21.0500 21.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 173 193.000000 9650.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 26 26.000000 1312.3000 50.4731
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 4702 12518.50000 832989.8500 66.5407
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 6.000000 652.5600 108.7600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 307 323.250000 16150.0000 49.9613
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 4.250000 106.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1123 1723.250000 86137.5000 49.9855
CONIP-CONIP-CONSULT, ITDS PHONE 47 25.000000 625.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 59 57.000000 2850.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 1 1.500000 37.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 46 52.250000 2612.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 181 189.500000 9475.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 11 21.000000 1539.7200 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1961 4771.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 35.750000 893.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1187 6517.250000 325467.0000 49.9393
INTR-T1013-INTERPRETER 267 491.000000 24550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1741 8748.000000 87451.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 62 300.750000 21434.2000 71.2692
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 86 455.250000 32465.9400 71.3145
PHY-97110HM-PT SESSION BY PT ASST 10 59.000000 3372.4400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 219 1173.750000 83089.7400 70.7900
SPL-92508-GROUP SPL SESSION PER CHILD 4 7.000000 97.1600 13.8800
TRAV-TRAVS-Travel by mile 710 40453.00000 18008.5600 0.4452
Subtotal (Total Children Is Unduplicated) 3418 65418.50000 717155.2200 10.9626
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Total 167164.250000 4545897.8200 27.1942
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Number of Children (Unduplicated) With at Least One Service 23288
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Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 43 35.000000 2186.5600 0.0000
U 0 0.000000 0.0000 0.0000
B 8433 5569.750000 225336.1700 0.0000
P 9 8.500000 518.5000 518.5000
D 246 234.250000 14408.5900 0.0000
S 142 133.000000 5437.6000 0.0000
H 406 460.500000 30204.0800 0.0000
T 5 2.250000 117.6900 0.0000
6484 4249.750000 135245.7900 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 15769 10693.250000 413464.2300 518.5000
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 5499 16622.250000 120115.2100 0.0000
---------------------------------------------------------
Total 5499 16622.250000 120115.2100 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3393 2364.500000 98217.7000 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 1 0.250000 9.2500 0.0000
7493 5314.500000 188003.5600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10891 7681.250000 286304.5100 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 53.750000 1988.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2086 3465.250000 128437.8000 0.0000
P 890 1094.500000 51292.1100 51292.1100
D 1 1.000000 75.0000 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
3711 3796.250000 163112.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6713 8410.750000 344905.9300 51292.1100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2786 1795.250000 70682.2500 0.0000
P 141 657.750000 9357.2300 9209.2300
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
3239 1865.750000 51929.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6167 4319.250000 131987.4800 9209.2300
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
13490 8861.250000 333433.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13490 8861.250000 333433.9400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 33 54.250000 3831.2500 0.0000
P 4503 3648.750000 146938.0000 146938.0000
D 193 143.500000 5713.2500 0.0000
S 23 40.250000 2751.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7054 4538.000000 135240.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11807 8426.750000 294548.0500 146938.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 414 438.000000 16770.0000 0.0000
P 15686 13686.750000 503468.7900 530881.4900
D 7 9.000000 575.6400 0.0000
S 0 0.000000 0.0000 0.0000
H 393 613.750000 32198.0000 0.0000
T 0 0.000000 0.0000 0.0000
166 183.000000 8175.8500 12.5000
Other 1 1.000000 50.0000 50.0000
---------------------------------------------------------
Total 16667 14931.500000 561238.2800 530943.9900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 30.750000 1137.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 9874 8102.000000 342080.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 58 35.000000 1295.0000 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
7035 5882.000000 220125.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17008 14049.750000 564639.0000 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 722 540.250000 21403.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 4 3.500000 167.5000 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
2273 1741.000000 64979.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2999 2284.750000 86550.6100 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 160 111.750000 4194.2500 0.0000
P 3237 2993.500000 143477.6200 139560.4600
D 106 114.750000 6231.6100 51.0500
S 9 20.000000 1285.0000 0.0000
H 103 155.000000 10397.6300 40.0000
T 3423 28271.750000 72146.3600 61248.1300
3329 2243.750000 58716.3400 761.2600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10367 33910.500000 296448.8100 201660.9000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 68.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 16 13.500000 647.5000 0.0000
P 3869 3533.306600 159167.5800 158694.4100
D 0 0.000000 0.0000 0.0000
S 27 23.500000 972.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12255 9514.193400 174789.3200 0.0000
Other 115 139.000000 7901.2500 0.0000
---------------------------------------------------------
Total 16284 13225.000000 343546.6500 158694.4100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 3.500000 186.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2746 2341.250000 97843.0000 0.0000
P 2997 2481.720000 108592.7500 108972.7500
D 179 139.750000 5955.5000 0.0000
S 109 116.500000 5447.5000 5382.7500
H 27 27.000000 1350.0000 0.0000
T 0 0.000000 0.0000 0.0000
10875 8287.530000 145949.0700 34.9000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 16936 13397.500000 365333.5700 114390.4000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 228 175.000000 6475.0000 0.0000
P 3318 2764.750000 113404.7500 113508.0000
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
4497 2509.488000 87492.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8049 5460.000000 208179.0500 113508.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 842 924.500000 37021.7500 0.0000
P 0 0.000000 0.0000 0.0000
D 16 15.750000 639.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 6 4.500000 249.7500 0.0000
T 2 2.000000 130.5000 0.0000
3687 3943.750000 157161.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4553 4890.500000 195202.5000 0.0000