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:TPIN
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 1 2.750000 101.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2 3.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 48 85.000000 3145.0000 37.0000
Subtotal (Total Children Is Unduplicated) 49 91.250000 3246.7500 35.5808
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 1 1.000000 48.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 5 8.500000 425.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 41.500000 2971.8500 71.6108
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 17.000000 1175.0000 69.1176
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 37.500000 3221.3200 85.9019
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 27 48.000000 2544.7500 53.0156
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 483 817.166668 60379.9000 73.8893
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 124 220.500000 16236.0400 73.6328
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 71 126.000000 9242.4900 73.3531
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 565 986.999999 54227.2100 54.9414
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 224 382.666667 29804.0000 77.8850
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 23 23.000000 5663.2100 246.2265
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 1351.0000 193.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 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 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 15 15.000000 750.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
Subtotal (Total Children Is Unduplicated) 975 2757.833334 189413.3700 68.6820
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
COUN-H2019HR-INDIVIDUAL/FAMILY THERAPY 1 2.000000 146.6400 73.3200
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 2.000000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 172 824.750000 41237.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 40 217.500000 15523.9600 71.3745
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 53 281.480000 20116.1900 71.4658
PHY-97110HM-PT SESSION BY PT ASST 5 12.000000 685.9200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 133 743.500000 52429.0900 70.5166
SPL-92508-GROUP SPL SESSION PER CHILD 6 6.750000 93.6900 13.8800
Subtotal (Total Children Is Unduplicated) 361 2096.980000 130450.1900 62.2086
-----------------------------------------------------------------------------------------------------------------------
Total 4946.063334 323110.3100 65.3268
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1301
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
S 3 4.500000 308.2500 0.0000
H 434 504.500000 33950.1300 0.0000
T 0 0.000000 0.0000 0.0000
282 308.000000 18237.3300 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 720 819.000000 52645.7100 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
4 4.500000 166.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 4.500000 166.5000 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 23 24.500000 3968.2800 3968.2800
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
94 91.500000 11197.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 117 116.000000 15166.0800 3968.2800
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
242 380.500000 24913.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 242 380.500000 24913.5000 0.0000
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 304 372.000000 23478.7000 23488.0300
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
94 136.500000 9024.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 421 531.500000 34146.7000 23488.0300
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 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
387 875.000000 58634.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 387 875.000000 58634.2500 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 34 40.250000 2530.2700 1712.7400
D 29 34.000000 1752.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 75 92.000000 6068.3600 90.0000
T 305 300.000000 17489.4600 11858.3400
168 213.000000 12742.2400 30.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 611 679.250000 40582.5800 13691.0800
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 20 19.028672 1040.7400 1682.9700
D 19 20.085585 1063.0000 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
564 609.885742 36767.8000 0.0000
Other 42 49.750000 2838.5200 0.0000
---------------------------------------------------------
Total 645 698.749999 41710.0600 1682.9700
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 3 3.000000 214.3200 308.1600
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
396 413.150000 26714.8000 0.0000
Other 24 25.830000 1689.7200 0.0000
---------------------------------------------------------
Total 423 441.980000 28618.8400 308.1600
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 15 30.000000 2250.0000 0.0000
T 0 0.000000 0.0000 0.0000
17 26.333335 1800.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 32 56.333335 4050.0000 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
285 343.250000 22476.0900 1403.3500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 285 343.250000 22476.0900 1403.3500