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: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 15165 42801.61686 1582588.8244 36.9750
Subtotal (Total Children Is Unduplicated) 15165 42801.61686 1582588.8244 36.9750
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 86 146.300000 10948.1500 74.8336
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 25 37.500000 2812.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 24.500000 1837.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 50 79.000000 5925.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 82 132.000000 7326.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1120 1740.500000 130640.2500 75.0590
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 459 689.500000 51712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 198 324.000000 24261.0000 74.8796
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1426 2158.000000 119769.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 528 850.800000 63727.5000 74.9030
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
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 64 66.000000 3300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 2409 6295.100000 424805.2100 67.4819
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EI Services,Class #03
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 5 15.000000 1099.8000 73.3200
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 22.000000 550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 718 3189.400000 159470.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 70 283.750000 20199.9000 71.1891
OCCT-97530HM-OT SESSION BY OT ASST 5 5.500000 314.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 133 567.750000 40517.2200 71.3645
PHY-97110HM-PT SESSION BY PT ASST 20 28.000000 1600.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 135 585.750000 40684.4400 69.4570
SPL-92508-GROUP SPL SESSION PER CHILD 6 12.000000 166.5600 13.8800
Subtotal (Total Children Is Unduplicated) 986 4709.150000 264603.0000 56.1891
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Total 53805.866860 2271997.0344 42.2258
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Number of Children (Unduplicated) With at Least One Service 15423
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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 4 3.500000 129.5000 0.0000
S 150 148.500000 8421.0000 0.0000
H 8063 5565.250000 231775.6300 198269.7500
T 2 0.500000 18.5000 0.0000
28 17.250000 638.2500 0.0000
Other 2 3.500000 262.5000 0.0000
---------------------------------------------------------
Total 8939 6194.000000 260694.8600 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 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 1860 2638.750000 102450.0800 0.0000
P 670 1011.750000 39569.6300 39698.6500
D 0 0.000000 0.0000 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
1401 1867.500000 77732.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3999 5602.750000 222887.5700 39698.6500
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 0 0.000000 0.0000 0.0000
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
11 7.750000 286.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2432 1608.750000 62374.2500 0.0000
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
5252 3577.750000 147828.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5252 3577.750000 147828.7500 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 2506 2276.250000 95990.2500 95370.7500
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 4168 3662.250000 152741.8000 95463.2500
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 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4949 4834.500000 192485.5000 189640.1700
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 3856 3431.000000 152099.0000 148908.5300
D 300 293.250000 14769.5000 0.0000
S 1340 1167.500000 50509.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 4.000000 200.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7639 6508.250000 280548.2500 148954.7800
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 1 2.000000 18.5000 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
11 4.500000 166.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1089 799.500000 30629.8200 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 1 0.750000 53.5800 0.0000
162 183.750000 10302.1200 0.0000
Other 2 3.000000 111.0000 55.5000
---------------------------------------------------------
Total 3044 2851.250000 134556.0300 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
406 370.750000 19324.4400 0.0000
Other 4 2.750000 170.6300 0.0000
---------------------------------------------------------
Total 3354 3094.250000 144851.1100 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
888 765.250000 33771.5000 0.0000
Other 17 15.250000 761.1300 0.0000
---------------------------------------------------------
Total 5818 4681.500000 209528.6300 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
0 0.000000 0.0000 0.0000
Other 2 2.500000 92.5000 92.5000
---------------------------------------------------------
Total 3493 2911.366860 120601.3244 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
0 0.000000 0.0000 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 2987 3617.250000 146884.7500 94419.5500