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:GR
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 870 888.750000 32865.2500 36.9792
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 733 736.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 736 2741.697840 101072.8200 36.8650
Subtotal (Total Children Is Unduplicated) 1421 4366.697840 133938.0700 30.6726
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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 1 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 13.500000 1012.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.000000 75.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 1.500000 112.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 11 17.000000 943.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 168 264.046200 19803.4700 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 78 115.959967 8457.0000 72.9303
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 59.500000 4462.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 231 321.000000 17787.7500 55.4136
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 73 142.000000 8062.5000 56.7782
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 15 15.000000 883.6500 58.9100
SCREEN-T1023-SCREENING 10 11.000000 550.0000 50.0000
Subtotal (Total Children Is Unduplicated) 375 973.506167 62720.8600 64.4278
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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 2 7.000000 350.0000 50.0000
INTR-T1013-INTERPRETER 36 61.750000 3113.0000 50.4130
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 272 495.000000 4950.0000 10.0000
TRAV-TRAVS-Travel by mile 261 8784.000000 3888.9500 0.4427
Subtotal (Total Children Is Unduplicated) 445 9559.750000 12351.9500 1.2921
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Total 14899.954007 209010.8800 14.0276
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Number of Children (Unduplicated) With at Least One Service 1493
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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 129 984.750000 2579.8200 2579.8200
D 3 14.750000 142.4900 0.0000
S 1 2.500000 92.5000 0.0000
H 1 0.250000 9.2500 0.0000
T 0 0.000000 0.0000 0.0000
489 325.250000 10630.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 623 1327.500000 13454.0600 2579.8200
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 50 1065.000000 2434.1600 2434.1700
6 419.000000 306.1200 0.0000
Other 430 2251.000000 8633.4400 0.0000
---------------------------------------------------------
Total 486 3735.000000 11373.7200 2434.1700
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 1 2.250000 104.0000 104.0000
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
634 568.000000 26266.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 637 574.250000 26530.0000 264.0000
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
459 517.750000 21891.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 459 517.750000 21891.4000 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 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 296 453.500000 7373.2400 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
315 236.000000 7942.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 321 244.000000 8242.2500 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 0 0.000000 0.0000 0.0000
P 10 11.000000 201.0000 201.0000
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
396 341.000000 11763.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 406 352.000000 11964.7500 201.0000
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 457 872.250000 21028.1400 21028.1400
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
10 13.000000 425.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 467 885.250000 21453.6400 21028.1400
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 4 4.000000 70.4900 70.4900
D 2 4.000000 148.0000 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
332 342.250000 13520.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 338 350.250000 13738.9900 70.4900
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 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
152 128.500000 4677.2500 75.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 168 145.000000 5346.0000 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.250000 83.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 85 1281.000000 1763.2400 1691.4900
253 235.750000 6806.8600 17.3600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 340 1519.000000 8653.3500 1708.8500
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 18 81.000000 122.0600 122.0600
T 20 112.000000 219.9400 219.9400
648 595.000000 9772.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 686 788.000000 10114.5800 342.0000
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 44 317.000000 850.6400 850.6400
T 102 842.500000 1509.0700 1509.0700
1002 1774.250000 16841.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1148 2933.750000 19200.8200 2359.7100
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 32 57.770700 3778.8100 3778.8100
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
594 447.683307 15933.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 626 505.454007 19712.0400 3778.8100
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 8 296.000000 189.0400 189.0400
213 273.250000 9773.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 221 569.250000 9962.0400 189.0400