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
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 15574 47824.50000 1768556.2500 36.9801
Subtotal (Total Children Is Unduplicated) 15574 47824.50000 1768556.2500 36.9801
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 77 117.000000 8775.0000 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 34 39.500000 2962.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 23.000000 1725.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 61 99.000000 7425.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 90 143.500000 7964.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 1 2.000000 111.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 947 1537.500000 115312.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 6 10.500000 787.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 415 612.000000 45862.5000 74.9387
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 12 19.500000 1462.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 254 391.500000 29362.5000 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 1158 1760.000000 97624.5000 55.4685
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 13 25.000000 1332.0000 53.2800
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 457 715.500000 53662.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 68 177.000000 8950.0000 50.5650
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 12 12.000000 612.6000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 2152 5716.500000 386042.3400 67.5312
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 17 32.000000 800.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 547 2326.000000 116300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 121 160.500000 8025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 126 573.000000 40935.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 40 47.500000 3382.7200 71.2152
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 116 494.250000 35309.2200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 29 46.000000 3286.2400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.000000 57.1600 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 4.000000 285.7600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 162 719.500000 51343.5200 71.3600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 34 39.750000 2825.4600 71.0808
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 4 19.000000 1357.3600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.7200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 954 4473.000000 264514.0800 59.1357
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Total 58014.000000 2419112.6700 41.6988
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Number of Children (Unduplicated) With at Least One Service 15751
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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 1 0.250000 9.2500 0.0000
S 1 0.500000 18.5000 0.0000
H 10570 7122.000000 298211.4500 297861.9900
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10574 7124.500000 298303.9500 297926.7400
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 1696 1085.750000 47280.5000 0.0000
---------------------------------------------------------
Total 1696 1085.750000 47280.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 232 130.000000 4837.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3006 2062.000000 85823.7500 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
68 71.500000 4813.2800 0.0000
Other 46 26.000000 962.0000 0.0000
---------------------------------------------------------
Total 3352 2289.500000 96436.7800 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 34 49.750000 1840.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1103 1594.000000 61738.7500 101.7500
P 2533 3897.750000 150531.7500 150064.7900
D 1 1.000000 75.0000 0.0000
S 2 4.000000 148.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
559 722.500000 31579.0000 0.0000
Other 4 6.000000 222.0000 0.0000
---------------------------------------------------------
Total 4236 6275.000000 246135.2500 150166.5400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 14.750000 685.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3081 2004.750000 77350.2000 52811.3700
P 0 0.000000 0.0000 0.0000
D 1 1.000000 37.0000 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 3103 2020.500000 78072.9500 52811.3700
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
5137 3690.250000 154847.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5137 3690.250000 154847.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 21 123.750000 6008.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 955 703.000000 27436.5000 0.0000
P 3286 2705.750000 113425.2500 114069.7000
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
54 37.750000 1410.8000 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 4317 3570.500000 148290.5500 114069.7000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 174 168.250000 6556.2500 0.0000
P 4026 4155.500000 165546.2500 165546.2500
D 52 47.500000 1757.5000 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 4253 4373.250000 174010.0000 165546.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 138 106.250000 4413.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1049 776.500000 30820.2500 9.2500
P 8534 6665.000000 276433.5000 286777.1000
D 18 18.250000 851.0000 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
4 12.000000 600.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9743 7578.000000 313117.7500 286786.3500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1062 783.250000 32870.3300 0.0000
P 364 292.000000 11422.5000 11273.7500
D 14 12.500000 538.0000 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
61 52.250000 1946.2500 0.0000
Other 1 1.000000 71.4400 0.0000
---------------------------------------------------------
Total 1502 1141.000000 46848.5200 11273.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 3.250000 120.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 315 287.250000 14058.4100 0.0000
P 1314 1295.250000 60248.6600 60075.1200
D 0 0.000000 0.0000 0.0000
S 469 452.750000 17240.7500 233.2500
H 35 42.000000 2818.6800 447.7600
T 0 0.000000 0.0000 0.0000
26 28.500000 2004.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2164 2109.000000 96491.0000 60756.1300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 4.250000 170.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 909 787.750000 34949.6500 1009.6900
P 3036 2643.000000 121859.5500 121741.2200
D 217 198.750000 13140.1700 71.4400
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
24 21.000000 1058.4400 150.0000
Other 19 22.000000 1432.2800 0.0000
---------------------------------------------------------
Total 4211 3676.750000 172610.3400 122972.3500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1251 1032.500000 48556.5500 157.2500
P 4806 3682.750000 160958.7200 167047.0000
D 199 172.750000 10739.0900 3.3000
S 0 0.000000 0.0000 0.0000
H 4 3.250000 126.7500 34.2500
T 0 0.000000 0.0000 0.0000
9 7.250000 307.2500 0.0000
Other 64 62.750000 3895.2700 0.0000
---------------------------------------------------------
Total 6333 4961.250000 224583.6300 167241.8000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1096 852.250000 34522.7800 129.5000
P 3345 2423.000000 96158.4900 112554.7900
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 3 3.000000 193.9300 0.0000
---------------------------------------------------------
Total 4444 3278.250000 130875.2000 112684.2900
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 341 339.750000 14367.2500 18.5000
P 4360 4486.500000 176276.0000 174138.4720
D 13 6.500000 240.5000 0.0000
S 1 3.000000 111.0000 111.0000
H 4 4.750000 213.7500 75.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4719 4840.500000 191208.5000 174342.9720