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:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 12616 14262.00000 527610.7500 36.9942
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7641 7412.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23128 93025.44958 3440299.1344 36.9823
Subtotal (Total Children Is Unduplicated) 24268 114699.6996 3967909.8844 34.5939
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 13.000000 630.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 74 78.750000 3937.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 672 1005.750000 50287.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 138 235.000000 17460.0000 74.2979
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 50 76.000000 5600.0000 73.6842
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 36.500000 2737.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 86 151.500000 11771.3200 77.6985
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 143 231.500000 12729.0000 54.9849
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2008 3260.833333 243720.1500 74.7417
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 792 1243.000000 92923.5400 74.7575
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 326 543.000000 40478.4900 74.5460
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2528 4072.999999 225500.2100 55.3646
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 895 1505.666667 113946.5000 75.6784
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 70 70.000000 8431.9800 120.4569
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 18 18.000000 1499.2200 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 18 18.000000 1608.6200 89.3678
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
SCREEN-T1023-SCREENING 157 164.000000 8200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 27.000000 1378.3500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 4958 12774.50000 844063.4700 66.0741
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 290 335.250000 16762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 22 14.500000 362.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 758 693.000000 34612.5000 49.9459
CONIP-CONIP-CONSULT, ITDS PHONE 40 25.000000 625.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 318 294.250000 14687.5000 49.9150
CONOP-CONOP-CONSULT, OT, PHONE 55 26.750000 668.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 389 313.500000 15625.0000 49.8405
CONPP-CONPP-CONSULT, PT, PHONE 8 4.750000 118.7500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 521 583.250000 29162.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 35 18.750000 468.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 12 32.000000 2346.2400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2046 4699.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 33.000000 825.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1015 4781.750000 239087.5000 50.0000
INTR-T1013-INTERPRETER 270 458.000000 22887.5000 49.9727
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1693 7863.000000 78330.0010 9.9618
OCCT-97530-OT SESSION BY LICENSED OT 124 625.000000 44521.6800 71.2347
OCCT-97530HM-OT SESSION BY OT ASST 8 8.500000 486.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 203 976.000000 69657.6200 71.3705
PHY-97110HM-PT SESSION BY PT ASST 29 48.500000 2772.2600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 313 1632.000000 114641.9500 70.2463
SPL-92508-GROUP SPL SESSION PER CHILD 17 27.750000 385.1700 13.8800
TRAV-TRAVS-Travel by mile 602 37360.00000 16623.5300 0.4450
Subtotal (Total Children Is Unduplicated) 3419 60853.50000 705658.4010 11.5960
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Total 188327.699579 5517631.7554 29.2980
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Number of Children (Unduplicated) With at Least One Service 24625
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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 56 40.000000 1648.0000 1304.7500
D 5 3.750000 138.7500 0.0000
S 179 164.000000 9121.5000 0.0000
H 8499 6070.500000 265753.5100 198269.7500
T 2 0.500000 18.5000 0.0000
6779 4489.750000 150707.1600 0.0000
Other 3 5.500000 412.5000 0.0000
---------------------------------------------------------
Total 16157 11189.500000 445601.4000 199574.5000
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 6700 16070.750000 137681.6400 0.0000
---------------------------------------------------------
Total 6700 16070.750000 137681.6400 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
6874 4630.750000 162435.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10489 7029.000000 262448.0400 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 1860 2638.750000 102450.0800 0.0000
P 693 1036.250000 43537.9100 43666.9300
D 7 8.250000 305.2500 0.0000
S 1 1.500000 55.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5981 6121.000000 253802.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8609 9889.000000 403231.3900 43666.9300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 44.500000 2917.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2375 1553.000000 59040.5000 0.0000
P 41 513.500000 3427.3300 3452.3300
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
2643 1855.750000 49818.9900 3261.4900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5105 3970.250000 115333.8200 6713.8200
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
13175 8204.000000 307289.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13175 8204.000000 307289.7500 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 2507 2276.750000 95990.2500 95407.7500
D 46 33.750000 1324.7500 0.0000
S 151 109.000000 4020.2500 0.0000
H 1 1.000000 37.0000 37.0000
T 0 0.000000 0.0000 0.0000
7280 4537.750000 139499.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11474 8207.250000 292046.0500 95500.2500
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 16949 14793.000000 550106.9000 561021.6500
D 23 23.000000 1643.1200 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
411 372.000000 17298.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17717 15507.750000 583875.6500 562098.1500
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 3859 3437.000000 152176.0000 149013.2800
D 333 319.500000 15740.7500 0.0000
S 1344 1169.500000 50537.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5921 5208.750000 200425.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13599 11747.250000 481849.2500 149059.5300
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 1 2.000000 18.5000 0.0000
D 13 10.000000 407.0000 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
2491 1876.500000 64006.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3571 2673.500000 94580.3400 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 1497 1421.000000 67590.6000 66426.3200
D 85 86.250000 4390.0700 605.0000
S 5 2.500000 92.5000 0.0000
H 250 273.250000 15382.2500 623.3500
T 2481 26276.500000 66012.5000 55237.8000
2794 1823.250000 63403.9900 103.8100
Other 2 3.000000 111.0000 55.5000
---------------------------------------------------------
Total 8330 30968.000000 265907.6400 123051.7800
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 1649 1506.028672 69328.8600 68824.0000
D 47 48.585585 2507.0200 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
11505 9172.135742 197116.0900 0.0000
Other 46 52.500000 3009.1500 0.0000
---------------------------------------------------------
Total 14545 12000.999999 328360.5200 70505.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.750000 397.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 2023 1682.500000 79189.7900 50.0000
P 2694 2107.500000 91446.2400 90843.9700
D 55 38.750000 1917.1000 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
12744 9480.670000 203546.4210 0.0000
Other 41 41.080000 2450.8500 0.0000
---------------------------------------------------------
Total 17728 13447.250000 382185.0910 94131.4700
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 15 30.000000 2250.0000 0.0000
T 0 0.000000 0.0000 0.0000
5017 27677.582720 1018367.3100 0.0000
Other 2 2.500000 92.5000 92.5000
---------------------------------------------------------
Total 8525 30618.949580 1141218.6344 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
3047 3187.000000 129137.7900 1597.3000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 6034 6804.250000 276022.5400 96016.8500