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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 871 889.000000 32874.5000 36.9792
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 791 772.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1731 6749.449730 249350.3900 36.9438
Subtotal (Total Children Is Unduplicated) 1747 8410.449730 282224.8900 33.5565
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Screening, Eval, and Assessment,Class #02
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.7100 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 1 1.000000 9.0800 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
EVAL-96111-DEVELOPMENTAL EVALUATION 3 10.000000 500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 65.500000 4875.0000 74.4275
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1012.5000 72.3214
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 24.000000 1800.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 51 78.500000 4356.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 765 1193.500000 89104.4960 74.6581
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 358 561.500000 41644.3100 74.1662
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 153 242.000000 18000.0000 74.3802
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 943 1437.000000 79423.2500 55.2702
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 330 539.000000 38754.7600 71.9012
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 21 21.000000 1801.1500 85.7690
SCREEN-T1023-SCREENING 14 16.000000 800.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1351 4216.500000 282930.2060 67.1007
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 216 211.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 31.000000 1550.0000 50.0000
INTR-T1013-INTERPRETER 37 65.250000 3288.0000 50.3908
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 272 499.000000 4990.0000 10.0000
TRAV-TRAVS-Travel by mile 265 8844.000000 3915.6300 0.4427
Subtotal (Total Children Is Unduplicated) 445 9651.250000 13793.6300 1.4292
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Total 22278.199730 578948.7260 25.9872
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Number of Children (Unduplicated) With at Least One Service 1767
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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 22 13.750000 508.7500 0.0000
P 182 1052.750000 6283.8200 6283.8200
D 3 14.750000 142.4900 0.0000
S 11 11.250000 700.7500 0.0000
H 308 296.500000 14215.7500 10682.0000
T 3 5.000000 308.2500 308.2500
499 341.750000 11740.7500 0.0000
Other 34 48.000000 3044.2500 55.5000
---------------------------------------------------------
Total 1062 1783.750000 36944.8100 17329.5700
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 55 1073.000000 3034.1600 3034.1700
10 426.500000 868.6200 0.0000
Other 606 2380.500000 14382.9400 0.0000
---------------------------------------------------------
Total 671 3880.000000 18285.7200 3034.1700
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 11.500000 425.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 496 535.250000 26174.2500 0.0000
P 44 50.250000 2557.5000 2557.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 4.000000 160.0000 160.0000
T 0 0.000000 0.0000 0.0000
637 571.250000 26500.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1194 1172.250000 55817.5000 2717.5000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 201 351.500000 14787.2500 0.0000
P 32 48.000000 3211.8800 3211.8800
D 0 0.000000 0.0000 0.0000
S 1 3.500000 129.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
691 854.250000 38575.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 925 1257.250000 56704.0100 3211.8800
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 101 88.750000 3397.7500 0.0000
P 14 63.000000 717.7500 717.7500
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
282 390.500000 6655.4900 1373.7400
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 399 544.250000 10882.9900 2091.4900
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 6 8.000000 300.0000 300.0000
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
487 435.750000 18772.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 493 443.750000 19072.2500 300.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 85 108.250000 5081.2500 0.0000
P 175 219.750000 10508.0000 10357.2500
D 0 0.000000 0.0000 0.0000
S 2 2.750000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
399 342.500000 11819.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 661 673.250000 27510.2500 10357.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 41.750000 2947.7500 606.7500
P 971 1655.500000 59635.8400 62307.0900
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
46 72.500000 4516.7500 600.0000
Other 72 107.500000 7731.0000 0.0000
---------------------------------------------------------
Total 1118 1877.250000 74831.3400 63513.8400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 9.250000 342.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 57 52.000000 2114.0000 0.0000
P 220 259.750000 12320.2400 12012.9900
D 16 22.250000 1229.0000 0.0000
S 55 72.500000 3285.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
391 461.750000 21439.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 748 877.500000 40730.7400 12012.9900
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 20.500000 879.2500 0.0000
P 16 16.500000 668.7500 668.7500
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
156 132.500000 4977.2500 75.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 201 169.500000 6525.2500 743.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 128 160.500000 7605.5000 0.0000
P 106 134.750000 6997.2500 6627.2400
D 16 24.500000 1324.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 30 48.500000 3253.0000 0.0000
T 110 1324.500000 4616.1300 4460.8800
319 343.250000 13624.4700 17.3600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 709 2036.000000 37421.1000 11105.4800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 110 117.000000 5472.7500 0.0000
P 183 197.750000 9209.7500 9074.8600
D 6 6.250000 334.5000 0.0000
S 8 7.750000 286.7500 286.7500
H 20 83.500000 280.3100 280.3100
T 20 112.000000 219.9400 219.9400
742 717.500000 16908.5800 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 1090 1243.250000 32825.0800 9861.8600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 250 264.250000 11746.7500 18.5000
P 297 295.000000 12530.2500 12716.7500
D 17 17.750000 656.7500 0.0000
S 24 15.750000 582.7500 582.7500
H 44 317.000000 850.6400 850.6400
T 105 847.000000 1758.8200 1758.8200
1271 2177.000000 35585.0400 0.0000
Other 4 6.000000 362.2500 0.0000
---------------------------------------------------------
Total 2012 3939.750000 64073.2500 15927.4600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 219 296.775135 13792.6800 0.0000
P 206 265.447455 14052.9500 14040.3400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1000.0000 0.0000
T 0 0.000000 0.0000 0.0000
721 691.977140 33041.2660 0.0000
Other 1 2.500000 92.5000 92.5000
---------------------------------------------------------
Total 1154 1270.699730 61979.3960 14132.8400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 116 191.500000 8092.7500 0.0000
P 191 273.500000 12388.2500 11824.8000
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 8 296.000000 189.0400 189.0400
281 348.750000 14675.0000 783.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 596 1109.750000 35345.0400 12796.8400