CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 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 12058 38103.25000 1408924.0000 36.9765
Subtotal (Total Children Is Unduplicated) 12058 38103.25000 1408924.0000 36.9765
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 77 116.000000 8700.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 41 55.500000 4125.0000 74.3243
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 36 48.500000 3637.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 47 60.500000 4537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 93 132.000000 7326.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1081 1771.500000 132843.0000 74.9890
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 459 665.500000 49883.2500 74.9560
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 255 378.500000 28387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1251 1845.000000 102314.2500 55.4549
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 430 702.000000 52575.0000 74.8932
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 62 70.000000 3500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 2330 5849.000000 398033.2000 68.0515
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 34.000000 850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 474 2088.250000 104387.5000 49.9880
OCCT-97530-OT SESSION BY LICENSED OT 96 364.750000 25989.9200 71.2541
OCCT-97530HM-OT SESSION BY OT ASST 3 3.500000 200.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 109 394.750000 28078.0600 71.1287
PHY-97110HM-PT SESSION BY PT ASST 6 26.000000 1486.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 117 454.000000 32433.7600 71.4400
Subtotal (Total Children Is Unduplicated) 789 3365.250000 193425.6000 57.4773
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Total 47317.500000 2000382.8000 42.2758
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Number of Children (Unduplicated) With at Least One Service 12370
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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 202 201.250000 14319.3000 0.0000
P 2 2.000000 100.0000 100.0000
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 204 203.250000 14419.3000 100.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 43 32.000000 1221.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3212 2452.750000 104620.8400 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3255 2484.750000 105841.8400 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 516 792.250000 29313.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1109 1654.250000 65618.0000 46.2500
P 3045 4646.250000 184091.4000 179553.9400
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 4670 7092.750000 279022.6500 179600.1900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2610 1773.500000 69898.1700 42287.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2610 1773.500000 69898.1700 42287.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 120 133.500000 4952.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 620 536.250000 21968.5000 0.0000
P 3011 2749.000000 119809.0000 119836.4500
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 3751 3418.750000 146730.0000 119836.4500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 178 187.250000 7501.0000 120.2500
P 4251 4763.000000 193056.5000 193056.5000
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 4431 4950.750000 200576.0000 193176.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 163.750000 6058.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3617 2974.500000 122701.0000 18.5000
P 6180 5104.000000 218829.3000 217635.9580
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 9986 8242.250000 347589.0500 217654.4580
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 5.000000 277.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 636 422.000000 16791.2500 0.0000
P 42 43.000000 2249.0000 2379.5000
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 683 470.000000 19317.7500 2379.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.500000 547.0000 18.5000
U 0 0.000000 0.0000 0.0000
B 312 303.500000 14945.7300 0.0000
P 1807 1789.500000 81799.9500 81591.3500
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 2132 2105.500000 97292.6800 81609.8500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 30.500000 1294.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1789 1688.500000 79867.0000 50.0000
P 1702 1651.250000 78498.1000 78357.6800
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 3528 3370.250000 159659.6000 78407.6800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 136 144.750000 5649.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 2692 2148.000000 98999.6900 55.5000
P 3326 2674.000000 118386.4300 5048115.1700
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 6154 4966.750000 223035.7600 5048170.6700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1025 863.250000 36804.5000 0.0000
P 3084 2715.750000 112422.5000 112153.0000
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 4109 3579.000000 149227.0000 112153.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 379 458.250000 17763.7500 55.0000
P 3571 4200.750000 169972.2500 166599.0200
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 3951 4660.000000 187773.0000 166654.0200