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
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 129 184.750000 6835.7500 37.0000
Subtotal (Total Children Is Unduplicated) 129 184.750000 6835.7500 37.0000
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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 13 22.500000 1650.0000 73.3333
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 18 35.000000 2385.0000 68.1429
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 6.500000 487.5000 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 35 60.500000 3357.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 229 378.500000 28200.0000 74.5046
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 158 296.500000 22080.0000 74.4688
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 78 140.500000 10537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 360 607.500000 33660.7500 55.4086
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 137 216.500000 16147.5000 74.5843
OCTF-97168-OT RE-EVAL EST PLAN CARE 15 15.000000 765.7500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 20 20.000000 1021.0000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 45 45.000000 2297.2500 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 8 8.000000 408.4000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 46 46.000000 2348.3000 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 49 49.000000 2501.4500 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 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 1012 1980.000000 129678.4800 65.4942
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 75.0800 75.0800
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 15.750000 393.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5454 42142.25000 2106493.8800 49.9853
OCCT-97530-OT SESSION BY LICENSED OT 468 2291.250000 163387.3800 71.3093
OCCT-97530HM-OT SESSION BY OT ASST 253 1191.249473 68139.4700 57.2000
PHY-97110-PT SESSION BY LICENSED PT 453 2514.250000 179164.7000 71.2597
PHY-97110HM-PT SESSION BY PT ASST 120 742.000000 42412.7200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 689 3890.000000 277707.5900 71.3901
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 17 56.000000 3203.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 9 26.500000 367.8200 13.8800
Subtotal (Total Children Is Unduplicated) 6558 52870.24947 2841345.5900 53.7419
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Total 55034.999473 2977859.8200 54.1085
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Number of Children (Unduplicated) With at Least One Service 7276
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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 1 1.000000 51.0500 51.0500
D 47 47.000000 2532.5200 0.0000
S 17 18.500000 1080.0100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 2.000000 150.0000 0.0000
Other 209 326.000000 20690.7500 83.2500
---------------------------------------------------------
Total 275 394.500000 24504.3300 134.3000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 59 56.250000 2081.2500 0.0000
P 59 95.000000 5097.2700 1276.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2293 9260.500000 472781.1300 0.0000
T 0 0.000000 0.0000 0.0000
184 350.250000 22250.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2595 9762.000000 502210.5000 1276.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 250.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 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
1 1.000000 50.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8 10.000000 400.0000 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
6442 6132.500000 317791.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6442 6132.500000 317791.0200 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 61 79.000000 4314.5000 4314.5000
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 61 79.000000 4314.5000 4314.5000
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
2406 7448.500000 423379.2700 141898.8400
Other 121 205.500000 15081.0000 0.0000
---------------------------------------------------------
Total 2527 7654.000000 438460.2700 141898.8400
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 6 19.000000 841.6400 300.0000
D 2 3.000000 214.3200 0.0000
S 42 132.000000 6600.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4300 13357.000000 715078.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4350 13511.000000 722734.7400 300.0000
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 1 8.250000 589.3800 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
531 1576.250000 93633.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 532 1584.500000 94223.0400 0.0000
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 4 7.000000 457.2000 0.0000
817 1706.500000 103544.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 821 1713.500000 104002.1300 0.0000
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
1509 1566.750000 82776.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1509 1566.750000 82776.4600 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
2706 2790.750000 143640.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2706 2790.750000 143640.8000 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
4066 4102.249473 249561.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4066 4102.249473 249561.0300 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
1681 5734.250000 293241.0000 293241.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1681 5734.250000 293241.0000 293241.0000