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
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 15018 44870.50000 1659330.7500 36.9804
Subtotal (Total Children Is Unduplicated) 15018 44870.50000 1659330.7500 36.9804
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 85 128.500000 9637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 58 84.000000 6262.5000 74.5536
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 33 46.500000 3487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 89 149.000000 11175.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 135 201.500000 11183.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1259 2039.500000 152943.0000 74.9904
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 651 1010.371733 75748.6300 74.9711
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 440 690.000000 51711.0000 74.9435
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1900 2943.000000 163281.0000 55.4811
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 764 1254.303467 93997.7600 74.9402
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 11 11.000000 561.5500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 69 69.000000 3522.4500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 12 12.000000 612.6000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 32 33.000000 1684.6500 51.0500
SCREEN-T1023-SCREENING 69 77.000000 3850.0000 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 36 38.000000 1939.9000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 3022 8807.675200 592668.2300 67.2900
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 31.000000 3014.4600 97.2406
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 27 67.750000 1693.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6479 49148.75000 2457254.0000 49.9963
OCCT-97530-OT SESSION BY LICENSED OT 610 2801.927212 199981.9400 71.3730
OCCT-97530HM-OT SESSION BY OT ASST 248 1233.250000 70541.8600 57.2000
PHY-97110-PT SESSION BY LICENSED PT 624 3094.750000 220828.1600 71.3557
PHY-97110HM-PT SESSION BY PT ASST 95 493.125262 28187.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 872 5228.000000 372445.5900 71.2405
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 16 39.750000 551.7300 13.8800
Subtotal (Total Children Is Unduplicated) 7882 62140.30247 3354612.9300 53.9845
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Total 115818.477674 5606611.9100 48.4086
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Number of Children (Unduplicated) With at Least One Service 16408
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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 201 200.750000 14300.8000 0.0000
P 2 2.000000 100.0000 100.0000
D 93 94.500000 4788.1000 0.0000
S 2432 1816.500000 79687.3700 0.0000
H 6550 4741.250000 198682.6200 198557.6000
T 0 0.000000 0.0000 0.0000
13 6.750000 284.1900 0.0000
Other 300 483.000000 30833.2500 0.0000
---------------------------------------------------------
Total 9591 7344.750000 328676.3300 198657.6000
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 1632 1118.750000 50388.0000 0.0000
---------------------------------------------------------
Total 1632 1118.750000 50388.0000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 31.500000 1202.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2945 2153.250000 90460.8400 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
45 57.500000 3736.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3031 2242.250000 95400.0700 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 498 753.000000 27861.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1041 1541.500000 60655.2500 46.2500
P 2836 4294.250000 169334.4000 164907.9400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2720 10354.500000 527702.1600 0.0000
T 0 0.000000 0.0000 0.0000
177 150.000000 9936.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7272 17093.250000 795489.5600 164954.1900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2473 1642.000000 64700.9200 39715.5000
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 0.500000 18.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2475 1642.500000 64719.4200 39715.5000
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
10934 9475.250000 462614.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10934 9475.250000 462614.7000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 112 128.500000 4767.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 596 508.000000 20658.2500 0.0000
P 2900 2605.000000 112601.5000 112578.9500
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
108 80.250000 3082.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3716 3321.750000 141109.5000 112578.9500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 167 170.000000 6787.7500 120.2500
P 4047 4414.250000 176548.0000 176548.0000
D 5 3.500000 129.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.500000 129.5000 259.0000
2420 7578.500000 426826.0800 0.0000
Other 143 248.500000 17964.7500 0.0000
---------------------------------------------------------
Total 6786 12417.750000 628404.0800 176927.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 180 151.000000 5587.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3445 2783.250000 114456.2500 18.5000
P 5905 4781.750000 203023.3000 201829.9580
D 6 6.250000 231.2500 0.0000
S 34 86.000000 4300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4575 14240.500000 768663.0300 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 14146 22049.250000 1096279.3300 201848.4580
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.000000 166.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 387.750000 15292.5000 0.0000
P 39 40.000000 2082.5000 2213.0000
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
1656 2601.500000 143163.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2291 3032.250000 160704.9900 2213.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.500000 547.0000 18.5000
U 0 0.000000 0.0000 0.0000
B 299 289.000000 14333.2300 0.0000
P 1701 1624.000000 73761.4500 73552.8500
D 0 0.000000 0.0000 0.0000
S 231 199.000000 7309.5000 0.0000
H 39 37.750000 2523.5800 74.9000
T 1 0.250000 9.2500 0.0000
1116 2226.750000 134196.4500 0.0000
Other 1 0.250000 9.2500 9.2500
---------------------------------------------------------
Total 3401 4389.500000 232689.7100 73655.5000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 23.750000 930.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1684 1562.750000 73842.7500 50.0000
P 1568 1508.250000 71943.1000 71828.9300
D 88 80.750000 5579.6200 0.0000
S 0 0.000000 0.0000 0.0000
H 28 29.250000 2030.9300 0.0000
T 0 0.000000 0.0000 0.0000
1408 1448.750000 74515.5800 0.0000
Other 29 27.000000 1793.8300 0.0000
---------------------------------------------------------
Total 4833 4680.500000 230636.5600 71878.9300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 133 139.750000 5464.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 2501 1956.000000 90214.9400 55.5000
P 3045 2394.750000 105882.9300 5035718.9000
D 84 83.000000 5222.7600 0.0000
S 0 0.000000 0.0000 0.0000
H 23 23.750000 1700.5500 0.0000
T 0 0.000000 0.0000 0.0000
2901 2983.750000 154818.9700 0.0000
Other 50 52.250000 3706.2900 64.7500
---------------------------------------------------------
Total 8737 7633.250000 367011.0800 5035839.1500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 931 731.250000 30704.5000 0.0000
P 2783 2347.500000 96061.2500 95831.0000
D 0 0.000000 0.0000 0.0000
S 1 1.303467 97.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4970 5112.174207 306925.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8685 8192.227674 433789.1100 95831.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 362 430.000000 16690.7500 55.0000
P 3342 3867.250000 155281.2500 151937.2700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 9 11.500000 862.5000 0.0000
T 1 1.000000 50.0000 50.0000
1931 6874.000000 345759.4700 345744.1400
Other 1 0.500000 18.5000 18.5000
---------------------------------------------------------
Total 5647 11185.250000 518699.4700 497804.9100