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
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 11649 13551.25000 501230.7500 36.9878
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 8158 8173.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7637 23354.25000 863737.7500 36.9842
Subtotal (Total Children Is Unduplicated) 17787 45078.50000 1364968.5000 30.2798
-----------------------------------------------------------------------------------------------------------------------
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 452 734.500000 36650.0000 49.8979
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 41.000000 3075.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 29.500000 2212.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 48.500000 2691.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 357 577.372667 43302.9500 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 132 197.500000 14812.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 62 104.500000 7837.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 518 719.000000 39904.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 211 333.000000 24975.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 61 61.000000 3266.5500 53.5500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 10 10.000000 757.2000 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 106.4400 26.6100
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 41.4600 41.4600
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 78 87.000000 4350.0000 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 15 15.000000 765.7500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 1562 3183.872667 194211.0700 60.9984
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 2.000000 37.9000 18.9500
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 181 187.000000 9350.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 9 17.000000 1246.4400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1961 4771.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 14.750000 368.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 237 1021.385000 51028.9000 49.9605
INTR-T1013-INTERPRETER 267 491.000000 24550.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1741 8747.000000 87441.0000 9.9967
OCCT-97530-OT SESSION BY LICENSED OT 17 51.750000 3668.5400 70.8897
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 31 127.750000 9069.3400 70.9929
PHY-97110HM-PT SESSION BY PT ASST 3 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 68 314.500000 22467.8800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TRAV-TRAVS-Travel by mile 709 40426.00000 17996.5000 0.4452
Subtotal (Total Children Is Unduplicated) 3252 58365.38500 336068.7600 5.7580
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Total 106627.757667 1895248.3300 17.7744
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Number of Children (Unduplicated) With at Least One Service 18642
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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 25 16.500000 775.3100 0.0000
S 3 2.250000 83.2500 0.0000
H 6 6.000000 407.2000 0.0000
T 0 0.000000 0.0000 0.0000
6350 4105.500000 126552.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6384 4130.250000 127818.4300 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 3720 15258.750000 60593.7100 0.0000
---------------------------------------------------------
Total 3720 15258.750000 60593.7100 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
7048 4790.750000 153218.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7048 4790.750000 153218.9500 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 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
2992 2848.750000 115070.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2992 2848.750000 115070.0300 0.0000
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 134 643.750000 8516.2700 8516.2700
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
3237 1862.250000 51800.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3371 2506.000000 60316.2700 8516.2700
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
7946 4543.250000 140398.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7946 4543.250000 140398.6900 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 193 143.500000 5713.2500 0.0000
S 11 22.000000 1650.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7020 4503.250000 133695.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7224 4668.750000 141058.3000 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 11299 9111.750000 309813.8200 309814.5000
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
36 56.500000 2085.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11335 9168.250000 311898.8200 309814.5000
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 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
6617 4981.500000 158745.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6675 5016.500000 160040.2500 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 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
2260 1714.250000 63129.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2264 1717.750000 63296.6100 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 8 6.750000 337.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3058 27881.750000 50188.4300 46259.3600
3128 2029.000000 45992.0500 17.8000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6194 29917.500000 96517.9800 46277.1600
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 17 15.500000 573.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11906 9152.825000 156894.6200 0.0000
Other 4 4.000000 200.0000 0.0000
---------------------------------------------------------
Total 11927 9172.325000 157668.1200 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 176 137.250000 5837.0000 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
10643 8042.310000 132758.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10819 8179.560000 138595.7200 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
4482 2490.622667 86151.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4482 2490.622667 86151.2000 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 16 15.750000 639.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 130.5000 0.0000
2170 2201.000000 81835.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2188 2218.750000 82605.2500 0.0000