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
Agency Filter:EXT
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 88 157.250000 5818.2500 37.0000
Subtotal (Total Children Is Unduplicated) 88 157.250000 5818.2500 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 28.500000 2137.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 22.500000 1687.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 44 75.000000 4162.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 213 340.000000 25500.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 158 299.371733 22452.8800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 113 204.500000 15298.5000 74.8093
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 471 818.000000 45399.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 190.000000 14250.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 5 5.000000 255.2500 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 67 67.000000 3420.3500 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 30 31.000000 1582.5500 51.0500
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 32 34.000000 1735.7000 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) 1074 2185.871733 142117.4200 65.0164
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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 16 33.750000 843.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5862 46444.25000 2322054.0000 49.9966
OCCT-97530-OT SESSION BY LICENSED OT 492 2256.177212 161075.6200 71.3932
OCCT-97530HM-OT SESSION BY OT ASST 243 1227.000000 70184.3600 57.2000
PHY-97110-PT SESSION BY LICENSED PT 495 2473.750000 176463.9200 71.3346
PHY-97110HM-PT SESSION BY PT ASST 89 473.125262 27043.8400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 716 4470.500000 319235.6300 71.4094
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 11 28.750000 399.0500 13.8800
Subtotal (Total Children Is Unduplicated) 6974 57440.30247 3080429.0300 53.6284
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Total 59783.424207 3228364.7000 54.0010
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Number of Children (Unduplicated) With at Least One Service 7679
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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 2 2.000000 100.0000 100.0000
D 93 94.500000 4788.1000 0.0000
S 41 47.500000 2844.6400 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 300 483.000000 30833.2500 0.0000
---------------------------------------------------------
Total 436 627.000000 38565.9900 100.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 37 37.750000 1396.7500 0.0000
P 133 158.000000 6773.1500 4571.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2890 10550.250000 535872.0600 4571.5000
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
6496 6151.000000 318458.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6496 6151.000000 318458.4500 0.0000
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 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
2420 7578.500000 426826.0800 0.0000
Other 143 248.500000 17964.7500 0.0000
---------------------------------------------------------
Total 2563 7827.000000 444790.8300 0.0000
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 3 8.500000 585.8000 120.0000
D 0 0.000000 0.0000 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
4565 14231.250000 768320.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4602 14325.750000 773206.5800 120.0000
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 1 2.000000 20.0000 20.0000
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
615 1889.250000 114947.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 616 1891.250000 114967.0100 20.0000
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 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
1014 2137.750000 129205.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1014 2137.750000 129205.4300 0.0000
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 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
1369 1415.000000 72885.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1369 1415.000000 72885.7500 0.0000
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 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
2784 2868.750000 147433.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2784 2868.750000 147433.0300 0.0000
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 2.000000 150.0000 0.0000
P 1 2.000000 150.0000 150.0000
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
4968 5110.674207 306870.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4970 5114.674207 307170.1000 150.0000
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 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 1 1.000000 50.0000 50.0000
1931 6874.000000 345759.4700 345744.1400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1932 6875.000000 345809.4700 345794.1400