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
Payclass Filters:GR
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 12437 13596.25000 502959.7500 36.9925
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 7278 6896.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8162 24282.00000 897879.0000 36.9771
Subtotal (Total Children Is Unduplicated) 18717 44774.50000 1400838.7500 31.2865
-----------------------------------------------------------------------------------------------------------------------
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 639 914.750000 45725.0000 49.9863
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 22 33.636800 2522.7600 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.500000 262.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 26.000000 1950.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 47.500000 2636.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 335 556.725599 41754.4200 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 181.000000 13575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 95 149.500000 11212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 549 773.000000 42901.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 185 285.786700 21434.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 20 20.000000 1178.2000 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 166.5800 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 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 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 94 105.000000 5250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 16.000000 816.8000 51.0500
Subtotal (Total Children Is Unduplicated) 1723 3260.399099 198786.0800 60.9699
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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 542 527.000000 26337.5000 49.9763
CONSP-CONSP-CONSULT, SLP, PHONE 30 14.750000 368.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2112 5082.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 8.000000 200.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 175 771.750000 38587.5000 50.0000
INTR-T1013-INTERPRETER 277 526.500000 26291.5000 49.9364
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1739 8553.000000 85510.0000 9.9977
OCCT-97530-OT SESSION BY LICENSED OT 36 128.250000 9147.9400 71.3290
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 32 160.000000 11430.4000 71.4400
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 347.250000 24807.5400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 5 22.000000 305.3600 13.8800
TRAV-TRAVS-Travel by mile 585 35205.00000 15662.6600 0.4449
Subtotal (Total Children Is Unduplicated) 3302 53028.50000 322449.3900 6.0807
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Total 101063.399099 1922074.2200 19.0185
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Number of Children (Unduplicated) With at Least One Service 19674
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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 2 1.750000 87.5000 0.0000
S 322 228.250000 9088.3400 0.0000
H 2 3.000000 171.4400 0.0000
T 0 0.000000 0.0000 0.0000
6180 3982.500000 133645.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6506 4215.500000 142992.5000 0.0000
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 3950 16788.750000 66558.3800 0.0000
---------------------------------------------------------
Total 3950 16788.750000 66558.3800 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
5611 3614.250000 122757.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5611 3614.250000 122757.2300 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 1 0.500000 18.5000 37.0000
D 17 20.000000 843.7500 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
4332 3832.250000 151689.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4350 3852.750000 152551.3000 37.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
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
2697 1626.750000 46117.7000 43.4500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2799 2320.000000 52173.0300 6089.5300
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
7302 3961.750000 126900.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7302 3961.750000 126900.0000 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 1 0.250000 9.2500 37.0000
D 11 7.750000 299.7500 0.0000
S 49 24.000000 804.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6616 3974.036700 123201.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6677 4006.036700 124315.3500 37.0000
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 10859 9332.500000 323388.6500 323388.6500
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
67 54.750000 1750.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10926 9387.250000 325138.9000 323388.6500
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
6302 4905.250000 161770.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6302 4905.250000 161770.0000 0.0000
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 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
1369 1020.000000 34455.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1370 1020.250000 34464.2500 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 2 30.000000 22.9000 22.9000
D 0 0.000000 0.0000 0.0000
S 96 69.000000 1896.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1780 21011.750000 42149.9200 36837.4600
1486 996.500000 27852.4900 68.2400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3364 22107.250000 71921.5600 36928.6000
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 3 3.000000 77.7500 96.2500
D 7 6.500000 240.5000 0.0000
S 2 2.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11607 8786.250000 146812.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11619 8797.750000 147130.2800 96.2500
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 0.250000 0.0000 27.7500
D 11 9.250000 502.6500 0.0000
S 2 2.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13646 10011.500000 175676.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13660 10023.000000 176189.5100 27.7500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.2500 0.0000
P 1 0.250000 9.2500 9.2500
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
5155 3113.112399 110289.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5157 3113.612399 110307.6800 9.2500
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
3141 2950.000000 106904.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3141 2950.000000 106904.2500 0.0000