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: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 14260 42644.75000 1577393.2500 36.9892
Subtotal (Total Children Is Unduplicated) 14260 42644.75000 1577393.2500 36.9892
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 72 116.000000 8700.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 48 59.500000 4462.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 58 102.500000 7687.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 96 135.000000 7492.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1051 1716.762000 128667.1500 74.9476
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 492 754.500000 56536.0000 74.9317
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 255 413.000000 30896.0000 74.8087
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1185 1824.500000 101259.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 586 903.000000 67687.5000 74.9585
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 26 26.000000 1392.3000 53.5500
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 75.7200 75.7200
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 186.2700 26.6100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 81 87.000000 4350.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 2416 6168.262000 420841.1900 68.2269
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 3 4.000000 293.2800 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 21.000000 525.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 844 4463.250000 223100.0000 49.9860
OCCT-97530-OT SESSION BY LICENSED OT 32 160.750000 11483.9800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 48 228.500000 16324.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 5 44.000000 2515.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 92 428.250000 30594.1800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 994 5353.750000 284891.0400 53.2134
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Total 54166.762000 2283125.4800 42.1499
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Number of Children (Unduplicated) With at Least One Service 14470
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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 216 212.250000 13307.1500 0.0000
S 139 130.750000 5354.3500 0.0000
H 1 1.000000 50.0000 0.0000
T 5 2.250000 117.6900 0.0000
56 46.000000 2662.4200 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 8903 6005.750000 249542.0900 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 1778 1361.500000 59371.5000 0.0000
---------------------------------------------------------
Total 1778 1361.500000 59371.5000 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
329 357.000000 23595.5400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3727 2723.750000 121896.4900 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 889 1093.000000 51163.2500 51163.2500
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
620 848.000000 35992.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3621 5461.000000 217657.5400 51163.2500
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 3 4.000000 148.0000 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 3.500000 129.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2792 1803.250000 70978.2500 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
5243 3853.500000 160937.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5243 3853.500000 160937.5000 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 0 0.000000 0.0000 0.0000
S 12 18.250000 1101.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
31 30.500000 1388.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4580 3753.750000 153332.5000 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 4132 4235.000000 171986.2500 199351.7500
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
1 0.500000 12.5000 12.5000
Other 1 1.000000 50.0000 50.0000
---------------------------------------------------------
Total 4548 4674.500000 188818.7500 199414.2500
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 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
24 28.500000 1167.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9939 8161.250000 344385.7500 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 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
5 7.750000 493.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 727 548.000000 21896.6400 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 3174 2915.500000 138381.8600 136781.0600
D 3 3.000000 214.3200 0.0000
S 9 20.000000 1285.0000 0.0000
H 10 9.250000 646.5400 0.0000
T 0 0.000000 0.0000 0.0000
94 87.000000 6037.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3450 3146.500000 150759.7400 136781.0600
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 3835 3501.500000 157539.7500 157485.0000
D 0 0.000000 0.0000 0.0000
S 10 8.000000 399.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
62 68.750000 2728.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3925 3593.250000 161382.7800 157485.0000
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 2981 2467.000000 107853.7500 107853.7500
D 3 2.500000 118.5000 0.0000
S 109 116.500000 5447.5000 5382.7500
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 5842 4931.000000 211458.5000 113236.5000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 51.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3548 2941.512000 119987.9500 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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 4.500000 249.7500 0.0000
T 0 0.000000 0.0000 0.0000
264 279.250000 13448.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1112 1208.250000 50719.5000 0.0000