CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 12268 39197.00000 1449022.7500 36.9677
Subtotal (Total Children Is Unduplicated) 12268 39197.00000 1449022.7500 36.9677
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 95 152.500000 11437.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 31 45.000000 3375.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 18 26.000000 1950.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 55 83.000000 6187.5000 74.5482
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 93 136.500000 7575.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1174 1856.000000 139162.5000 74.9798
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 357 489.000000 36535.0000 74.7137
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 306 440.000000 32952.5000 74.8920
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1265 1884.500000 104534.2500 55.4705
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 529 855.500000 64125.0000 74.9562
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 48 50.000000 2500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2453 6029.000000 410896.5500 68.1534
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 13 20.500000 512.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 532 2515.360000 125767.8600 49.9999
OCCT-97530-OT SESSION BY LICENSED OT 89 401.250000 28651.0600 71.4045
OCCT-97530HM-OT SESSION BY OT ASST 2 7.000000 400.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 99 453.750000 32401.6200 71.4085
PHY-97110HM-PT SESSION BY PT ASST 3 3.000000 171.4800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 473.500000 33826.8400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 816 3875.360000 221745.6400 57.2194
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Total 49101.360000 2081664.9400 42.3953
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Number of Children (Unduplicated) With at Least One Service 12582
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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 211 227.500000 13331.6000 0.0000
P 4 3.000000 111.0000 111.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 215 230.500000 13442.6000 111.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 83 57.000000 2109.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3493 2450.500000 104457.2500 0.0000
P 2 0.750000 27.7500 27.7500
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3578 2508.250000 106594.0000 27.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 527 856.750000 31663.7500 37.0000
U 0 0.000000 0.0000 0.0000
B 828 1123.750000 44970.7500 0.0000
P 3633 5220.000000 206519.0900 201679.9200
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 4988 7200.500000 283153.5900 201716.9200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 11.250000 501.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2395 1571.000000 60621.7500 43378.9900
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2410 1582.250000 61122.7500 43378.9900
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 3 3.000000 111.0000 111.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 3.000000 111.0000 111.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 10.750000 397.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2111 1841.250000 78632.4500 129.5000
P 1454 1418.000000 60926.2500 61085.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3575 3270.000000 139956.4500 61214.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 345 377.000000 15821.2500 0.0000
P 4416 4841.250000 196861.5000 200487.5000
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 4763 5219.750000 212738.2500 200487.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 114 81.750000 3024.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2859 2195.750000 86692.5000 0.0000
P 6748 5808.250000 249372.9700 249187.5000
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 9721 8085.750000 339090.2200 249187.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 250.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 265 206.250000 10930.0800 0.0000
P 345 256.500000 10868.2500 10867.7500
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 615 467.750000 22048.3300 10867.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.750000 743.3900 0.0000
U 0 0.000000 0.0000 0.0000
B 289 301.750000 14234.5800 0.0000
P 1854 1904.750000 88268.9900 88307.0200
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 2158 2219.250000 103246.9600 88307.0200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 9.500000 454.8200 0.0000
U 0 0.000000 0.0000 0.0000
B 2524 2375.360000 112943.7300 336.5000
P 1794 1703.000000 77931.0200 77691.8200
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 4328 4087.860000 191329.5700 78028.3200
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 110 106.000000 4369.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 3253 2814.750000 134643.6800 145.4400
P 3180 2675.750000 118433.3200 117735.5900
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 6543 5596.500000 257446.7200 117881.0300
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1751 1510.000000 63338.7500 96.2500
P 2913 2457.750000 99682.2500 108155.4800
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 4664 3967.750000 163021.0000 108251.7300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 222 266.000000 11344.7500 18.5000
P 3749 4396.250000 177018.7500 173275.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3971 4662.250000 188363.5000 173293.5000