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: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 9 6.750000 249.7500 37.0000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 3 1.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 114 227.500000 8408.2500 36.9593
Subtotal (Total Children Is Unduplicated) 117 236.000000 8658.0000 36.6864
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-EXIT ASSESSMENT 4 6.000000 300.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 46.863200 3469.7400 74.0398
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 10.000000 750.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 3.000000 175.0000 58.3333
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 48.500000 3637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 32 63.000000 3496.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 447 791.510402 58256.4500 73.6016
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 141 260.500000 18873.2300 72.4500
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 132 212.500000 15636.9900 73.5858
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 454 797.000000 43898.8000 55.0801
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 210 345.643967 25501.1100 73.7785
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 2432.0000 304.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 1014.0000 507.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 7 7.000000 350.0000 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 6 6.000000 291.3000 48.5500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 901 2610.517569 178233.6600 68.2752
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EI Services,Class #03
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 4 3.500000 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 142 753.640000 37682.1400 50.0002
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 365.250000 26079.2200 71.4010
OCCT-97530HM-OT SESSION BY OT ASST 1 3.750000 214.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 55 347.750000 24896.8400 71.5941
PHY-97110HM-PT SESSION BY PT ASST 2 11.000000 628.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 147 857.000000 58776.9500 68.5845
SPL-92508-GROUP SPL SESSION PER CHILD 3 13.000000 180.4400 13.8800
Subtotal (Total Children Is Unduplicated) 387 2359.890000 148568.8500 62.9558
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Total 5206.407569 335460.5100 64.4322
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Number of Children (Unduplicated) With at Least One Service 1328
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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 1 1.000000 50.0000 0.0000
S 203 218.500000 13780.2100 0.0000
H 332 367.250000 24672.0800 0.0000
T 0 0.000000 0.0000 0.0000
120 124.250000 7179.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 656 711.000000 45681.7700 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
25 14.000000 518.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25 14.000000 518.0000 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 4 3.000000 445.3100 445.3100
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
88 82.500000 8747.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 85.500000 9192.3100 445.3100
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
284 447.000000 30551.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 284 447.000000 30551.2500 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 4 3.713300 278.5000 278.5000
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 32.500000 2437.5000 0.0000
T 0 0.000000 0.0000 0.0000
160 127.250000 4747.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 182 165.463300 7613.2500 278.5000
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 365 458.250000 28772.0800 28927.7600
D 4 4.000000 285.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 71.4400 55.6900
41 49.500000 3042.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 411 512.750000 32171.7500 28983.4500
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
360 835.000000 56284.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 360 835.000000 56284.5000 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 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
2 2.000000 130.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 2.000000 130.5000 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 72 93.250000 6318.4300 3474.7500
D 0 0.000000 0.0000 0.0000
S 16 13.250000 481.0000 0.0000
H 63 78.750000 5314.2300 0.0000
T 327 333.250000 18576.5200 12768.8700
180 198.500000 11012.0800 145.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 717.000000 41702.2600 16388.6200
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 31 26.630000 1668.4900 2807.0700
D 24 24.000000 1457.2800 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
547 564.510000 34148.1600 0.0000
Other 133 134.000000 8319.0000 0.0000
---------------------------------------------------------
Total 736 749.390000 45602.1800 2807.0700
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 27 23.830000 1771.6300 1796.2900
D 2 2.000000 142.8800 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
474 504.420000 34884.5800 0.0000
Other 98 97.500000 6901.0800 0.0000
---------------------------------------------------------
Total 601 627.750000 43700.1700 1796.2900
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 0.666667 50.0000 50.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
34 49.637602 3697.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 38 56.304269 4197.8200 50.0000
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 7 11.750000 519.5000 505.6300
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
221 271.500000 17595.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 228 283.250000 18114.7500 505.6300