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:EIP DEI DEIP
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 12442 13603.00000 503209.5000 36.9925
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7355 6948.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 23177 70095.75000 2591666.0000 36.9732
Subtotal (Total Children Is Unduplicated) 24535 90647.50000 3094875.5000 34.1419
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 102 106.500000 5325.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 643 920.750000 46025.0000 49.9864
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 142 224.500000 16792.5000 74.7996
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 41 64.000000 4800.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 22 33.000000 2425.0000 73.4848
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 105 194.000000 14550.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 160 255.000000 14152.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1993 3264.902667 243723.3700 74.6495
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 720 1107.500000 82258.2300 74.2738
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 563 862.500000 64339.4900 74.5965
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2393 3840.000000 212729.8000 55.3984
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 946 1575.430667 117697.6100 74.7082
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 34 34.000000 3963.6600 116.5782
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 5 5.000000 1263.8700 252.7740
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 140.5200 23.4200
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 36.4900 36.4900
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 149 161.000000 8050.0000 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 27 31.000000 1567.5500 50.5661
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 5039 12719.08333 841479.7800 66.1588
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 310 361.750000 18058.9400 49.9211
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 12 6.750000 168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 766 643.750000 32162.5000 49.9612
CONIP-CONIP-CONSULT, ITDS PHONE 18 9.250000 231.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 529 334.250000 16700.0000 49.9626
CONOP-CONOP-CONSULT, OT, PHONE 16 7.500000 187.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 444 308.000000 15387.5000 49.9594
CONPP-CONPP-CONSULT, PT, PHONE 14 6.000000 150.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 542 528.000000 26387.5000 49.9763
CONSP-CONSP-CONSULT, SLP, PHONE 30 14.750000 368.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2112 5086.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 32.500000 812.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 965 4784.250000 239212.5000 50.0000
INTR-T1013-INTERPRETER 277 526.500000 26291.5000 49.9364
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1739 8555.000000 85530.0000 9.9977
OCCT-97530-OT SESSION BY LICENSED OT 201 1064.500000 76005.1600 71.3999
OCCT-97530HM-OT SESSION BY OT ASST 5 13.750000 786.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 217 1166.500000 83374.0600 71.4737
PHY-97110HM-PT SESSION BY PT ASST 11 27.000000 1543.3200 57.1600
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 362 1928.250000 135307.0500 70.1709
SPL-92508-GROUP SPL SESSION PER CHILD 12 53.000000 735.6400 13.8800
TRAV-TRAVS-Travel by mile 586 35206.00000 15663.1000 0.4449
Subtotal (Total Children Is Unduplicated) 3562 60664.50000 775589.0200 12.7849
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Total 164031.083334 4711944.3000 28.7259
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Number of Children (Unduplicated) With at Least One Service 24936
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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 197 209.500000 12124.8500 0.0000
P 4 3.000000 111.0000 111.0000
D 5 4.750000 258.9400 0.0000
S 3959 2991.250000 136640.3600 0.0000
H 6102 4344.500000 187467.1500 162623.6300
T 1 0.500000 18.5000 0.0000
6328 4120.750000 141377.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16596 11674.250000 477997.9400 162734.6300
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 5834 18087.500000 124454.8800 0.0000
---------------------------------------------------------
Total 5834 18087.500000 124454.8800 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 76 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3194 2153.250000 90841.0000 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
5638 3631.500000 123471.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8910 5836.250000 216217.9800 27.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 490 783.750000 28962.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 733 980.500000 38992.5000 0.0000
P 3243 4675.250000 182943.8100 181208.4900
D 18 21.500000 899.2500 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
4592 4059.750000 169993.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9076 10520.750000 421792.2500 181208.4900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 11.250000 501.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2311 1502.000000 57935.7500 41575.2400
P 101 693.000000 6046.0800 6046.0800
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
2709 1635.000000 46422.9500 43.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5136 3841.250000 110905.7800 47664.7700
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
12591 8166.500000 320214.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12594 8169.500000 320325.0000 111.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 9.750000 360.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2035 1740.250000 73773.7000 129.5000
P 1398 1335.463300 57110.5000 57297.0000
D 13 10.000000 459.0000 0.0000
S 53 29.500000 1121.2500 0.0000
H 17 32.500000 2437.5000 0.0000
T 0 0.000000 0.0000 0.0000
6941 4219.536700 132450.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10466 7377.000000 267712.8000 57426.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 357.000000 14796.2500 0.0000
P 15511 14412.500000 539175.9800 542957.6600
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 214 316.250000 15716.2500 0.0000
T 4 7.000000 404.4400 505.6900
112 108.250000 4940.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16179 15206.500000 575374.9000 543463.3500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 104 74.250000 2747.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2759 2080.750000 81605.5000 0.0000
P 6422 5412.500000 230266.0000 230146.2500
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
6665 5742.500000 218137.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15950 13310.000000 532756.5000 230146.2500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 250.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 255 197.000000 10550.8300 0.0000
P 338 246.500000 10386.2500 10385.7500
D 1 0.250000 9.2500 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
1855 1395.250000 48395.7500 0.0000
Other 1 1.000000 55.5000 0.0000
---------------------------------------------------------
Total 2455 1845.000000 69647.5800 10385.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.750000 743.3900 0.0000
U 0 0.000000 0.0000 0.0000
B 260 259.750000 12169.5800 0.0000
P 1784 1832.750000 85378.5700 82455.5000
D 0 0.000000 0.0000 0.0000
S 117 86.750000 2632.7500 75.0000
H 101 114.000000 7812.1000 0.0000
T 2107 21345.000000 60726.4400 49606.3300
1705 1230.500000 41123.2700 213.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6089 24881.500000 210586.1000 132350.0700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.000000 325.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2318 2144.110000 102468.7300 186.5000
P 1670 1537.630000 70696.5100 71614.3900
D 63 63.250000 3731.3300 0.0000
S 3 2.250000 9.2500 0.0000
H 43 42.750000 3054.0600 0.0000
T 0 0.000000 0.0000 0.0000
12156 9352.760000 181103.0700 0.0000
Other 167 157.750000 9222.9400 0.0000
---------------------------------------------------------
Total 16426 13306.500000 370611.2100 71800.8900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 106 99.250000 4119.9700 0.0000
U 0 0.000000 0.0000 0.0000
B 2939 2487.000000 119424.4300 108.4400
P 2914 2401.330000 106892.2000 106307.6300
D 104 101.750000 6818.0700 0.0000
S 2 2.000000 10.0000 0.0000
H 38 37.000000 2621.8400 37.0000
T 0 0.000000 0.0000 0.0000
14149 10544.920000 212159.1600 0.0000
Other 169 150.250000 8921.7100 27.7500
---------------------------------------------------------
Total 20421 15823.500000 460967.3800 106480.8200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1576 1315.000000 55135.7500 77.7500
P 2657 2157.666667 86324.5000 89842.9300
D 0 0.000000 0.0000 0.0000
S 2 2.666666 200.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 1 0.750000 27.7500 27.7500
5228 3189.500001 115074.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9467 6671.583334 257212.2500 89948.4300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 199 237.250000 10062.7500 0.0000
P 3500 4021.250000 160819.5000 157299.0300
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
3362 3221.500000 124499.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7061 7480.000000 295381.7500 157299.0300