CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2020 ending 03/31/2020 Date of Report:05/15/2020 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 12418 39685.25000 1467440.5000 36.9770
Subtotal (Total Children Is Unduplicated) 12418 39685.25000 1467440.5000 36.9770
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 73 116.500000 8737.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 31 38.000000 2850.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 19.500000 1462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 39 57.000000 4275.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 76 114.500000 6354.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 913 1494.000000 112050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 8 13.500000 1012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 389 568.500000 42600.0000 74.9340
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 18 27.500000 2062.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 219 334.000000 25050.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1021 1539.500000 85414.5000 55.4820
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 14 26.500000 1415.2500 53.4057
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 381 614.500000 46050.0000 74.9390
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 8 14.000000 1050.0000 75.0000
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 66 175.000000 8850.0000 50.5714
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 2002 5183.500000 351203.8500 67.7542
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 29.000000 725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 415 1719.750000 85987.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 85 119.250000 5962.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 67 247.750000 17699.2600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 26 33.000000 2357.5200 71.4400
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 3.000000 214.3200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 78 265.250000 18949.4600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 24 37.500000 2679.0000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 4.000000 285.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 105 445.000000 31733.2400 71.3107
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 27 32.250000 2289.6600 70.9972
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 4 17.000000 1214.4800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.7200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 2 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 695 2959.250000 170476.0200 57.6078
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Total 47828.000000 1989120.3700 41.5890
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Number of Children (Unduplicated) With at Least One Service 12586
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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 1.750000 64.7500 64.7500
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 2 1.750000 64.7500 64.7500
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 238 135.500000 5041.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3202 2278.250000 95633.5000 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 3440 2413.750000 100674.7500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 50.750000 1877.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1268 1802.000000 70009.5000 101.7500
P 2759 4278.000000 166826.6700 164337.3100
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4064 6130.750000 238713.9200 164439.0600
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 14.750000 685.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3197 2112.000000 81565.4500 55809.8700
P 1 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 3219 2128.750000 82351.2000 55909.8700
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 123.750000 6008.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 975 725.750000 28430.2500 0.0000
P 3367 2835.000000 119859.2500 120553.7000
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 4363 3684.500000 154298.2500 120553.7000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 181 176.750000 6927.7500 0.0000
P 4204 4423.250000 178742.2500 178742.2500
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 4386 4602.000000 185820.0000 178742.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 139 107.500000 4459.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1084 814.500000 32311.0000 9.2500
P 8926 7135.500000 298022.3600 307781.3500
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 10149 8057.500000 334792.6100 307790.6000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1114 828.750000 34664.8300 0.0000
P 381 307.500000 12088.5000 11939.7500
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 1495 1136.250000 46753.3300 11939.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 324 303.750000 15124.9100 150.0000
P 1382 1396.750000 65254.1600 65080.6200
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 1711 1703.750000 80499.3200 65230.6200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 170.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 982 872.750000 38963.1500 1335.4400
P 3311 2911.750000 134050.3000 135772.2200
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 4299 3788.750000 173183.7000 137107.6600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1417 1200.750000 56538.5500 157.2500
P 5343 4234.000000 185384.9700 191275.7500
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 6760 5434.750000 241923.5200 191433.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1181 974.000000 40243.5300 129.5000
P 3646 2777.500000 112010.9900 128246.2900
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 4827 3751.500000 152254.5200 128375.7900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 355 366.000000 15413.5000 18.5000
P 4464 4628.000000 182377.0000 180150.6720
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 4819 4994.000000 197790.5000 180169.1720