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
Payclass Filters:GR
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 12615 14259.25000 527509.0000 36.9942
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7554 7354.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8519 49972.58272 1848469.5600 36.9897
Subtotal (Total Children Is Unduplicated) 18765 71586.08272 2375978.5600 33.1905
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 12 12.000000 582.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 70 70.250000 3512.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 670 1003.750000 50187.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 42.200000 3165.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 35.000000 2625.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 37.500000 2081.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 367 626.166665 46925.0000 74.9401
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 171 264.000000 19800.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 93.000000 6975.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 544 783.500000 43484.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 184 272.200000 20415.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 24 24.000000 1413.8400 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 13 13.000000 1082.7700 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 23.4200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 78 83.000000 4150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
Subtotal (Total Children Is Unduplicated) 1751 3406.566665 209310.6400 61.4433
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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 521 582.250000 29112.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 35 18.750000 468.7500 25.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 6 15.000000 1099.8000 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2046 4697.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 7.000000 175.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 167 749.600000 37480.0000 50.0000
INTR-T1013-INTERPRETER 270 458.000000 22887.5000 49.9727
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1693 7861.000000 78310.0010 9.9618
OCCT-97530-OT SESSION BY LICENSED OT 30 121.750000 8654.9400 71.0878
OCCT-97530HM-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 32 126.770000 9024.2100 71.1857
PHY-97110HM-PT SESSION BY PT ASST 3 6.000000 342.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 284.500000 20224.6400 71.0884
SPL-92508-GROUP SPL SESSION PER CHILD 5 9.000000 124.9200 13.8800
TRAV-TRAVS-Travel by mile 602 37348.00000 16618.1900 0.4450
Subtotal (Total Children Is Unduplicated) 3244 53993.62000 308100.3110 5.7062
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Total 128986.269385 2893389.5110 22.4318
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Number of Children (Unduplicated) With at Least One Service 19652
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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 0 0.000000 0.0000 0.0000
D 1 0.250000 9.2500 0.0000
S 26 11.000000 392.2500 0.0000
H 2 0.750000 27.7500 0.0000
T 0 0.000000 0.0000 0.0000
6469 4164.500000 131831.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6498 4176.500000 132260.8300 0.0000
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 4585 14668.250000 76593.6400 0.0000
---------------------------------------------------------
Total 4585 14668.250000 76593.6400 0.0000
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 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
6806 4564.500000 157985.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6806 4564.500000 157985.1500 0.0000
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 7 8.250000 305.2500 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
4486 4162.000000 164872.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4493 4170.250000 165177.7400 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 41 513.500000 3427.3300 3452.3300
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
2632 1848.000000 49532.2400 3261.4900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2673 2361.500000 52959.5700 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
7679 4244.750000 134510.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7679 4244.750000 134510.5000 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 1 0.500000 0.0000 37.0000
D 45 33.250000 1306.2500 0.0000
S 49 36.250000 1313.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7211 4475.000000 136684.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7306 4545.000000 139304.2500 37.0000
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 11660 9372.250000 322097.3000 322097.3000
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
310 228.750000 8023.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11970 9601.000000 330121.0500 322097.3000
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 3 6.000000 77.0000 104.7500
D 33 26.250000 971.2500 0.0000
S 4 2.000000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5533 4329.750000 141590.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5573 4364.000000 142666.7500 104.7500
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 0 0.000000 0.0000 0.0000
D 2 2.000000 111.0000 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
2480 1872.000000 63839.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2482 1874.000000 63950.5200 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 27 28.000000 1422.0000 525.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2175 25975.750000 48469.4600 43379.4600
2457 1408.500000 40072.8500 58.4700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4659 27412.250000 89964.3100 43962.9300
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 1 1.000000 50.0000 50.0000
D 10 15.500000 725.5000 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
10518 8173.500000 140069.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10529 8190.000000 140845.4700 50.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 50.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 26 20.500000 927.5000 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
11460 8302.270000 143060.1210 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11487 8323.770000 144037.6210 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
4996 27649.249385 1016493.3100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4996 27649.249385 1016493.3100 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
2761 2841.250000 106518.8000 51.0500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2761 2841.250000 106518.8000 51.0500