CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 11644 33376.61875 1234187.6444 36.9776
Subtotal (Total Children Is Unduplicated) 11644 33376.61875 1234187.6444 36.9776
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 81 137.800000 10273.1500 74.5512
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 30.500000 2287.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 25.000000 1875.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 41 67.000000 5025.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 80 129.500000 7187.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1104 1733.200000 129867.7500 74.9295
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 331 519.000000 38925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 200 318.500000 23848.5000 74.8776
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1164 1762.000000 97680.0000 55.4370
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 387 647.300000 48375.0000 74.7335
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 7 7.000000 412.3700 58.9100
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 66 69.000000 3450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2165 5454.800000 369610.7100 67.7588
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 11 19.000000 475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 633 2650.900000 132495.0000 49.9811
OCCT-97530-OT SESSION BY LICENSED OT 47 179.000000 12773.5200 71.3604
OCCT-97530HM-OT SESSION BY OT ASST 8 15.500000 886.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 87 293.250000 20906.9400 71.2939
PHY-97110HM-PT SESSION BY PT ASST 22 41.000000 2343.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 82 316.250000 21886.1000 69.2051
SPL-92508-GROUP SPL SESSION PER CHILD 5 8.000000 111.0400 13.8800
Subtotal (Total Children Is Unduplicated) 819 3522.900000 191877.7600 54.4659
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Total 42354.318750 1795676.1144 42.3965
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Number of Children (Unduplicated) With at Least One Service 11997
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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 656 429.250000 18310.2300 0.0000
P 63 45.500000 1865.5500 1522.3000
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 719 474.750000 20175.7800 1522.3000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 52 29.750000 1100.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3968 2815.500000 121118.7500 0.0000
P 148 147.500000 6837.2500 6837.2500
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 4168 2992.750000 129056.7500 6837.2500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 83.250000 3080.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2120 3046.500000 119318.5800 0.0000
P 752 1146.250000 46156.6500 42464.9000
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 2939 4276.000000 168555.4800 42464.9000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 50.500000 3242.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2479 1643.000000 62484.5000 0.0000
P 2 4.000000 100.0000 150.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2523 1697.500000 65827.0000 150.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1568 1354.250000 56144.8000 55.5000
P 2732 2564.000000 110611.7500 109841.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4306 3921.250000 166867.5500 109897.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 13.500000 632.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 347 348.000000 17142.5000 1683.2500
P 4829 4883.750000 194222.5000 207799.1700
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 5192 5245.250000 211997.5000 209482.4200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 208 144.000000 5328.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2000 1529.750000 60098.5000 46.2500
P 4078 3705.750000 165190.3900 161151.0300
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 6286 5379.500000 230616.8900 161197.2800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1091 803.250000 30926.3200 0.0000
P 2 10.250000 607.8800 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1095 815.000000 31608.2000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.000000 143.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1339 1239.750000 56386.7300 0.0000
P 1563 1504.500000 71300.8300 70954.2000
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 2907 2747.250000 127831.0600 70954.2000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1344 1283.000000 59727.9900 118.5000
P 1809 1679.750000 77186.8700 75841.6300
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 3160 2971.000000 137296.1100 75960.1300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.750000 397.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 2272 1945.750000 90886.5400 68.5000
P 2988 2399.500000 103762.1700 103252.5600
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 5270 4354.000000 195045.9000 103321.0600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2329 2123.275135 90330.1800 150.0000
P 1548 1276.043615 53195.4644 53068.9500
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 3877 3399.318750 143525.6444 53218.9500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1151 1476.750000 59536.7500 166.5000
P 2141 2604.000000 107735.5000 106002.8500
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 3292 4080.750000 167272.2500 106169.3500