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
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 15263 42986.36686 1589424.5744 36.9751
Subtotal (Total Children Is Unduplicated) 15263 42986.36686 1589424.5744 36.9751
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Screening, Eval, and Assessment,Class #02
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 1 1.000000 13.8700 13.8700
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 1 1.000000 27.8300 27.8300
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 98 168.800000 12598.1500 74.6336
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 43 72.500000 5197.5000 71.6897
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 31.000000 2325.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 55 88.000000 6600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 115 192.500000 10683.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1340 2119.000000 158840.2500 74.9600
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 616 986.000000 73792.5000 74.8403
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 276 464.500000 34798.5000 74.9160
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1775 2765.500000 153429.7500 55.4799
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 647 1067.300000 79875.0000 74.8384
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 1354.9300 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.000000 416.4500 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 163.9400 23.4200
OCTF-97168-OT RE-EVAL EST PLAN CARE 15 15.000000 765.7500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 22 22.000000 1123.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 46 46.000000 2348.3000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 9 9.000000 459.4500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 50 50.000000 2552.5000 51.0500
SCREEN-T1023-SCREENING 69 71.000000 3550.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 51 51.000000 2603.5500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 146.8200 48.9400
Subtotal (Total Children Is Unduplicated) 2783 8275.100000 554483.6900 67.0063
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 75.0800 75.0800
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 15.000000 1099.8000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 37.750000 943.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6145 45331.65000 2265963.8800 49.9864
OCCT-97530-OT SESSION BY LICENSED OT 538 2575.000000 183587.2800 71.2960
OCCT-97530HM-OT SESSION BY OT ASST 258 1196.749473 68454.0700 57.2000
PHY-97110-PT SESSION BY LICENSED PT 586 3082.000000 219681.9200 71.2790
PHY-97110HM-PT SESSION BY PT ASST 140 770.000000 44013.2000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 822 4475.750000 318392.0300 71.1371
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 56.000000 3203.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 15 38.500000 534.3800 13.8800
Subtotal (Total Children Is Unduplicated) 7448 57579.39947 3105948.5900 53.9420
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Total 108840.866333 5249856.8544 48.2342
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Number of Children (Unduplicated) With at Least One Service 16762
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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 634 415.500000 17801.4800 0.0000
P 57 41.000000 1699.0500 1355.8000
D 51 50.500000 2662.0200 0.0000
S 167 167.000000 9501.0100 0.0000
H 8063 5565.250000 231775.6300 198269.7500
T 2 0.500000 18.5000 0.0000
29 19.250000 788.2500 0.0000
Other 211 329.500000 20953.2500 83.2500
---------------------------------------------------------
Total 9214 6588.500000 285199.1900 199708.8000
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 2115 1402.500000 61088.0000 0.0000
---------------------------------------------------------
Total 2115 1402.500000 61088.0000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 18.250000 675.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3472 2280.250000 94944.5000 0.0000
P 105 99.500000 4383.7500 4383.7500
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 1 0.250000 9.2500 0.0000
64 61.750000 4283.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3679 2460.000000 104296.3900 4383.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 83.250000 3080.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1919 2695.000000 104531.3300 0.0000
P 729 1106.750000 44666.9000 40975.1500
D 0 0.000000 0.0000 0.0000
S 1 1.500000 55.5000 0.0000
H 2293 9260.500000 472781.1300 0.0000
T 0 0.000000 0.0000 0.0000
1585 2217.750000 99982.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6594 15364.750000 725098.0700 40975.1500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 49.500000 3167.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2375 1553.000000 59040.5000 0.0000
P 2 4.000000 100.0000 150.0000
D 10 3.500000 129.5000 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
12 8.750000 336.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2440 1618.750000 62774.2500 150.0000
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
11694 9710.250000 465619.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11694 9710.250000 465619.7700 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1483 1246.000000 51063.5500 55.5000
P 2567 2355.250000 100304.7500 99685.2500
D 1 0.500000 18.5000 0.0000
S 102 72.750000 2706.7500 0.0000
H 1 1.000000 37.0000 37.0000
T 0 0.000000 0.0000 0.0000
69 62.750000 2814.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4229 3741.250000 157056.3000 99777.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 13.500000 632.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 318 306.250000 14194.7500 1076.5000
P 4615 4514.750000 177658.2500 188563.6700
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
2406 7448.500000 423379.2700 141898.8400
Other 121 205.500000 15081.0000 0.0000
---------------------------------------------------------
Total 7476 12488.500000 630945.7700 331539.0100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 199 134.750000 4985.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1943 1477.750000 57984.5000 46.2500
P 3862 3450.000000 152940.6400 149208.5300
D 302 296.250000 14983.8200 0.0000
S 1382 1299.500000 57109.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4301 13361.000000 715278.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11989 20019.250000 1003282.9900 149254.7800
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1062 782.750000 30047.0700 0.0000
P 2 10.250000 607.8800 0.0000
D 11 8.000000 296.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 1 0.500000 18.5000 0.0000
T 0 0.000000 0.0000 0.0000
542 1580.750000 93800.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1621 2384.000000 124852.8600 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 1211 1079.250000 48781.2300 0.0000
P 1463 1380.750000 65060.3300 64713.5800
D 20 17.000000 697.8800 0.0000
S 5 2.500000 92.5000 0.0000
H 175 181.250000 9313.8900 533.3500
T 5 7.750000 510.7800 0.0000
979 1890.250000 113847.0500 0.0000
Other 2 3.000000 111.0000 55.5000
---------------------------------------------------------
Total 3865 4564.750000 238558.1600 65302.4300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.250000 381.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1234 1166.000000 54255.2400 118.5000
P 1628 1486.000000 68238.1200 67091.0300
D 18 13.000000 718.5200 0.0000
S 55 46.000000 1655.7500 1563.2500
H 2 1.500000 107.1600 0.0000
T 0 0.000000 0.0000 0.0000
1915 1937.500000 102100.9000 0.0000
Other 4 2.750000 170.6300 0.0000
---------------------------------------------------------
Total 4863 4661.000000 227627.5700 68772.7800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.750000 397.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 2022 1681.500000 79139.7900 50.0000
P 2691 2104.500000 91231.9200 90535.8100
D 29 18.250000 989.6000 0.0000
S 161 88.000000 3237.5000 3237.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3594 3556.000000 177412.3000 0.0000
Other 17 15.250000 761.1300 0.0000
---------------------------------------------------------
Total 8524 7472.250000 353169.4300 93823.3100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2110 1826.500000 76537.5000 150.0000
P 1381 1082.366860 43971.3244 43857.4200
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
4066 4102.249473 249561.0300 0.0000
Other 2 2.500000 92.5000 92.5000
---------------------------------------------------------
Total 7559 7013.616333 370162.3544 44099.9200
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1035 1285.250000 51444.0000 166.5000
P 1950 2330.500000 95347.2500 94178.0500
D 1 1.000000 75.0000 75.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1681 5734.250000 293241.0000 293241.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 4668 9351.500000 440125.7500 387660.5500