CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Agency Filter:EXT
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 122 173.500000 6419.5000 37.0000
Subtotal (Total Children Is Unduplicated) 122 173.500000 6419.5000 37.0000
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Screening, Eval, and Assessment,Class #02
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 3.000000 51.5500 17.1833
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 16.500000 1237.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 27.500000 2062.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 67.000000 3718.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 223 365.500000 27412.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 135 261.000000 19575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 100 182.500000 13687.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 399 664.500000 36818.7500 55.4082
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 143 216.000000 16200.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 12 12.000000 612.6000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 765.7500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 37 37.000000 1888.8500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 40 40.000000 2042.0000 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 32 34.000000 1735.7000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 7 7.000000 357.3500 51.0500
Subtotal (Total Children Is Unduplicated) 1034 1980.500000 130278.6500 65.7807
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 19.750000 493.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5859 46274.25000 2312442.1400 49.9725
OCCT-97530-OT SESSION BY LICENSED OT 419 2053.250000 146684.1800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 197 1139.743010 65164.7000 57.1749
PHY-97110-PT SESSION BY LICENSED PT 387 2179.750000 155664.7800 71.4141
PHY-97110HM-PT SESSION BY PT ASST 99 599.750000 34281.7100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 610 3436.250000 245467.8400 71.4348
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 12.000000 686.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 7 17.000000 235.9600 13.8800
Subtotal (Total Children Is Unduplicated) 6759 55731.74301 2961121.4600 53.1317
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Total 57885.743010 3097819.6100 53.5161
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Number of Children (Unduplicated) With at Least One Service 7444
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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 130 130.000000 6650.0800 3950.0800
D 107 111.000000 5589.8300 0.0000
S 9 12.500000 787.1300 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 372 494.000000 29688.4500 0.0000
---------------------------------------------------------
Total 618 747.500000 42715.4900 3950.0800
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 2 2.000000 100.0000 0.0000
---------------------------------------------------------
Total 2 2.000000 100.0000 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 44 44.750000 1655.7500 0.0000
P 162 168.000000 7544.7300 4736.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2542 10804.500000 549833.7000 0.0000
T 0 0.000000 0.0000 0.0000
109 325.250000 23042.3200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2857 11342.500000 582076.5000 4736.0000
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
6407 6188.250000 318879.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6407 6188.250000 318879.3900 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 1 2.000000 71.6400 71.6400
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 71.6400 71.6400
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 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
2387 7390.000000 406975.9000 0.0000
Other 159 268.000000 19622.2500 0.0000
---------------------------------------------------------
Total 2546 7658.000000 426598.1500 0.0000
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 0 0.000000 0.0000 0.0000
S 35 78.000000 3900.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4437 13857.750000 738581.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4472 13935.750000 742481.3800 0.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1 4.000000 285.7600 285.7600
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
732 1966.000000 117771.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 734 1970.750000 118085.5000 285.7600
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 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 1.000000 51.0500 51.0500
625 1392.250000 84640.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 626 1393.250000 84691.8300 51.0500
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1868 1934.500000 99382.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1868 1934.500000 99382.2000 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 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
2830 2920.000000 148591.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2830 2920.000000 148591.7300 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
4548 4520.243010 268253.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4548 4520.243010 268253.9000 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
1538 5271.000000 265891.9000 265891.9000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1538 5271.000000 265891.9000 265891.9000