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:EIP DEI DEIP
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 14936 44713.25000 1653512.5000 36.9804
Subtotal (Total Children Is Unduplicated) 14936 44713.25000 1653512.5000 36.9804
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 74 109.500000 8212.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 43 55.500000 4125.0000 74.3243
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 29 39.500000 2962.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 77 126.500000 9487.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 92 126.500000 7020.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1048 1699.500000 127443.0000 74.9885
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 493 711.000000 53295.7500 74.9589
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 327 485.500000 36412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1431 2125.000000 117882.0000 55.4739
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 658 1064.303467 79747.7600 74.9295
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 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 60 68.000000 3400.0000 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 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 2601 6621.803467 450550.8100 68.0405
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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 629 2704.500000 135200.0000 49.9908
OCCT-97530-OT SESSION BY LICENSED OT 118 545.750000 38906.3200 71.2896
OCCT-97530HM-OT SESSION BY OT ASST 5 6.250000 357.5000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 129 621.000000 44364.2400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 6 20.000000 1143.2000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 157 757.500000 53209.9600 70.2442
SPL-92508-GROUP SPL SESSION PER CHILD 5 11.000000 152.6800 13.8800
Subtotal (Total Children Is Unduplicated) 1006 4700.000000 274183.9000 58.3370
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Total 56035.053467 2378247.2100 42.4421
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Number of Children (Unduplicated) With at Least One Service 15201
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2391 1769.000000 76842.7300 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9155 6717.750000 290110.3400 198557.6000
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 1004 1503.750000 59258.5000 46.2500
P 2703 4136.250000 162561.2500 160336.4400
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
177 150.000000 9936.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4382 6543.000000 259617.5000 160382.6900
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
4438 3324.250000 144156.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4438 3324.250000 144156.2500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4223 4590.750000 183613.2500 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 5902 4773.250000 202437.5000 201709.9580
D 6 6.250000 231.2500 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
10 9.250000 342.2500 0.0000
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 9544 7723.500000 323072.7500 201728.4580
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 38 38.000000 2062.5000 2193.0000
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
1041 712.250000 28216.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1675 1141.000000 45737.9800 2193.0000
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
102 89.000000 4991.0200 0.0000
Other 1 0.250000 9.2500 9.2500
---------------------------------------------------------
Total 2387 2251.750000 103484.2800 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
39 33.750000 1629.8300 0.0000
Other 29 27.000000 1793.8300 0.0000
---------------------------------------------------------
Total 3464 3265.500000 157750.8100 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
117 115.000000 7385.9400 0.0000
Other 50 52.250000 3706.2900 64.7500
---------------------------------------------------------
Total 5953 4764.500000 219578.0500 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 930 729.250000 30554.5000 0.0000
P 2782 2345.500000 95911.2500 95681.0000
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
2 1.500000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3715 3077.553467 126619.0100 95681.0000
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 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 0.500000 18.5000 18.5000
---------------------------------------------------------
Total 3715 4310.250000 172890.0000 152010.7700