CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/20/2020 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 11254 37153.00000 1374315.0000 36.9907
Subtotal (Total Children Is Unduplicated) 11254 37153.00000 1374315.0000 36.9907
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 15.500000 1162.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 36 61.000000 4575.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 14 24.500000 1837.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 7.000000 388.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 29 44.500000 2469.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 45 88.000000 6600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 592 1055.833333 79080.2500 74.8984
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 13.000000 975.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 157 260.500000 19537.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 14.500000 1087.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 217 360.500000 27037.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 49.500000 2747.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 625 1063.500000 58974.2500 55.4530
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 47.500000 3562.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 191 336.000000 25200.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 16 16.000000 800.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 1255 3503.333333 239245.5000 68.2908
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 69 145.000000 7250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 257 1015.500000 50775.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 42 91.500000 6536.7600 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 2 2.000000 142.8800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 74 219.000000 15645.3600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 9 27.000000 1928.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 27 44.000000 3143.3600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 11 14.250000 1018.0200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 63 197.500000 14048.5600 71.1319
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 33.000000 2357.5200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 47 66.500000 4750.7600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 37 131.000000 9358.6400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 96 295.000000 21074.8000 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 5.500000 76.3400 13.8800
Subtotal (Total Children Is Unduplicated) 563 2288.750000 138249.7600 60.4040
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Total 42945.083333 1751810.2600 40.7919
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Number of Children (Unduplicated) With at Least One Service 11369
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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 1 0.750000 27.7500 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.750000 27.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 179 147.500000 5954.9600 0.0000
U 0 0.000000 0.0000 0.0000
B 3213 2142.250000 83145.2500 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 3392 2289.750000 89100.2100 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 450 592.500000 21922.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 3026 4382.250000 162128.2500 0.0000
P 552 745.500000 29138.2000 25866.4200
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 4028 5720.250000 213188.9500 25866.4200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 33.500000 2121.8200 0.0000
U 0 0.000000 0.0000 0.0000
B 3137 2012.250000 75627.4000 44146.0000
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 3165 2045.750000 77749.2200 44146.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 17.500000 647.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1116 807.000000 32059.2500 0.0000
P 2681 2003.750000 81831.5000 81790.8000
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 3815 2828.250000 114538.2500 81790.8000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 51.500000 2183.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 626 701.250000 27478.0000 0.0000
P 3914 4082.750000 162166.2500 162166.2500
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 4580 4835.500000 191827.7500 162166.2500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 491 376.000000 14234.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2750 2030.750000 82615.5000 0.0000
P 7235 5173.500000 212612.8900 211600.4250
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 10476 7580.250000 309462.3900 211600.4250
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 932 719.250000 28839.1700 0.0000
P 3 2.500000 99.0000 74.0000
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 950 729.750000 29234.1700 74.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1373 1417.500000 63314.7000 0.0000
P 277 250.250000 9505.4400 9560.9400
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 1653 1673.750000 73270.1400 9560.9400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 17.000000 760.0700 0.0000
U 0 0.000000 0.0000 0.0000
B 2546 2177.500000 103948.4600 0.0000
P 963 853.000000 41094.6700 40907.8800
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 3536 3047.500000 145803.2000 40907.8800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.500000 261.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 2461 2054.750000 92940.9600 9.2500
P 1608 1322.750000 57413.1600 57276.0900
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 4076 3382.000000 150615.3300 57285.3400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2631 2254.583333 99733.0900 92.5000
P 2211 1388.250000 54906.3100 55758.4100
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 4842 3642.833333 154639.4000 55850.9100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 687 798.250000 31330.7500 157.2500
P 4331 4370.250000 171013.5000 168361.8000
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 5019 5168.750000 202353.5000 168519.0500