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
Agency Filter:EXT
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 88 151.750000 5614.7500 37.0000
Subtotal (Total Children Is Unduplicated) 88 151.750000 5614.7500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 23.500000 1762.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 17.500000 1312.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.500000 637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 57.500000 3191.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 192 289.000000 21675.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 123 225.000000 16875.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 73 128.500000 9637.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 420 711.500000 39378.2500 55.3454
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 147 238.446133 17883.4600 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 14 14.000000 714.7000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 57 59.000000 3011.9500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 17 17.000000 867.8500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 71 71.000000 3624.5500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 63 71.000000 3624.5500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 12 12.000000 612.6000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 13 13.000000 636.2200 48.9400
Subtotal (Total Children Is Unduplicated) 1055 1995.946133 127780.9800 64.0203
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 25.000000 2641.9700 105.6788
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 14.250000 356.2500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5779 46176.00000 2308672.5000 49.9972
OCCT-97530-OT SESSION BY LICENSED OT 498 2281.250000 162904.2600 71.4101
OCCT-97530HM-OT SESSION BY OT ASST 283 1265.250000 72372.3000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 468 2369.190090 169195.1300 71.4148
PHY-97110HM-PT SESSION BY PT ASST 154 730.400105 41749.6700 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 721 3953.503920 281532.4300 71.2109
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 29 137.250000 7850.7000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 26 38.500000 534.3800 13.8800
Subtotal (Total Children Is Unduplicated) 6922 56990.59412 3047809.5900 53.4792
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Total 59138.290248 3181205.3200 53.7926
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Number of Children (Unduplicated) With at Least One Service 7545
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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 123 125.500000 6117.6200 0.0000
S 102 131.500000 8257.1200 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 242 354.000000 22835.2500 0.0000
---------------------------------------------------------
Total 467 611.000000 37209.9900 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 37.0000
U 0 0.000000 0.0000 0.0000
B 34 37.500000 1387.5000 0.0000
P 153 163.750000 7596.3400 4304.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3005 11870.500000 606255.7700 0.0000
T 0 0.000000 0.0000 0.0000
150 198.750000 11354.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3343 12271.500000 626630.7500 4341.9900
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 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
5860 5641.250000 291018.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5860 5641.250000 291018.9100 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 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
1 1.500000 112.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.500000 112.5000 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 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
2488 7769.500000 437469.6700 0.0000
Other 156 266.000000 19296.7500 0.0000
---------------------------------------------------------
Total 2644 8035.500000 456766.4200 0.0000
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 2 1.500000 85.7200 20.0000
D 2 2.000000 100.0000 0.0000
S 32 81.000000 4575.2800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4361 13937.000000 736527.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4397 14021.500000 741288.4400 20.0000
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 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
620 1882.000000 113809.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 620 1882.000000 113809.6700 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 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
926 1971.750000 119041.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 926 1971.750000 119041.8800 0.0000
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 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
1107 1159.250000 63254.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1107 1159.250000 63254.5900 0.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1 1.500000 83.2500 22.5000
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
2481 2557.500000 131837.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2482 2559.000000 131920.8700 22.5000
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 1 2.000000 150.0000 150.0000
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
3709 3799.040248 230707.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3710 3801.040248 230857.1100 150.0000
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
2128 7183.000000 369294.1900 369294.1900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2128 7183.000000 369294.1900 369294.1900