CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
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 14472 47842.50000 1769761.7500 36.9914
Subtotal (Total Children Is Unduplicated) 14472 47842.50000 1769761.7500 36.9914
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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 50 76.500000 5737.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 29 39.000000 2925.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.500000 337.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 18 30.000000 2250.0000 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 33 54.500000 4062.5000 74.5413
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 12.500000 693.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 73 112.500000 6243.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 46 90.000000 6750.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 745 1283.170133 96054.0100 74.8568
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 42.000000 3150.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 314 521.500000 39112.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 19.500000 1462.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 335 585.000000 43836.0000 74.9333
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 45 85.500000 4745.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 969 1625.000000 90127.6500 55.4632
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 35 61.000000 4575.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 374 707.500000 53062.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 10 10.000000 510.5000 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 8 9.000000 459.4500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
SCREEN-T1023-SCREENING 45 47.000000 2350.0000 50.0000
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 10.000000 510.5000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 7 7.000000 357.3500 51.0500
SPCH-92524GT-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
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1720 5524.170133 374538.5000 67.8000
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 639.5400 213.1800
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1776 9286.500000 464265.0000 49.9935
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3350 20466.25000 1023272.5000 49.9980
OCCT-97530-OT SESSION BY LICENSED OT 155 655.250000 46811.0600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 204 885.500000 63260.1200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 64 202.750000 11597.3000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 44 222.000000 12698.4000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 24 53.750000 3768.4600 70.1109
OCCT-97530TLGT-OT SESSION BY LICENSED OT 124 470.750000 33630.3800 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 8 28.000000 1601.6000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 218 812.250000 58027.1400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 217 782.000000 55495.2600 70.9658
PHY-97110HM-PT SESSION BY PT ASST 42 255.500000 14604.3800 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 11 29.250000 1671.9300 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 36 79.750000 5697.3400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 96 396.000000 28229.4000 71.2864
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 283 1313.000000 93800.7200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 337 1398.000000 99873.1200 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 71 211.500000 15109.5600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 154 556.750000 39774.2200 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 9 10.500000 145.7400 13.8800
Subtotal (Total Children Is Unduplicated) 5569 38122.25000 2074201.9700 54.4092
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Total 91488.920133 4218502.2200 46.1094
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Number of Children (Unduplicated) With at Least One Service 15083
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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 100 99.000000 5116.7800 0.0000
S 4212 2761.750000 112808.1600 0.0000
H 6686 4464.000000 185874.3100 185874.3100
T 0 0.000000 0.0000 0.0000
22 18.000000 701.7500 0.0000
Other 57 96.500000 6819.2500 0.0000
---------------------------------------------------------
Total 11078 7440.000000 311348.0000 185874.3100
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 1548 955.000000 42135.5000 0.0000
---------------------------------------------------------
Total 1548 955.000000 42135.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 172 137.750000 5481.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 3147 2079.750000 80624.2500 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
62 64.750000 4273.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3381 2282.250000 90379.2400 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 444 582.750000 21561.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2971 4297.750000 159001.7500 0.0000
P 548 739.250000 28906.9500 25635.1700
D 0 0.000000 0.0000 0.0000
S 1 2.000000 74.0000 0.0000
H 1700 5872.250000 299470.3000 0.0000
T 0 0.000000 0.0000 0.0000
271 308.000000 20158.0000 0.0000
Other 3 8.000000 434.1000 200.0000
---------------------------------------------------------
Total 5938 11810.000000 529606.8500 25835.1700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 26 31.000000 1934.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 3054 1930.750000 72554.9000 41748.7500
P 0 0.000000 0.0000 0.0000
D 1 1.500000 112.5000 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
5 3.250000 120.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3086 1966.500000 74721.9700 41748.7500
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
10915 8645.750000 398169.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10915 8645.750000 398169.8200 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.000000 444.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1059 758.250000 30020.7500 0.0000
P 2588 1902.000000 76852.0000 76811.3000
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
17 16.000000 592.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3677 2688.250000 107908.7500 76811.3000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 50.500000 2146.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 593 638.000000 24876.2500 0.0000
P 3737 3761.500000 147262.0000 147262.0000
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 3 13.000000 481.0000 425.5000
1586 5198.250000 287939.9400 0.0000
Other 107 208.500000 15140.2500 0.0000
---------------------------------------------------------
Total 6065 9869.750000 477845.9400 147687.5000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 464 352.250000 13355.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2640 1921.000000 77683.7500 0.0000
P 6950 4871.750000 198621.3900 197608.9050
D 84 52.000000 2074.0000 0.0000
S 93 181.000000 12061.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2856 9196.250000 506953.8600 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 13089 16576.000000 810814.0000 197608.9050
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 906 690.250000 27513.9200 0.0000
P 3 2.500000 99.0000 74.0000
D 15 13.000000 481.0000 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
160 383.750000 24474.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1099 1097.500000 52863.9400 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 1333 1360.500000 60598.7000 0.0000
P 270 242.000000 9200.1900 9255.6900
D 0 0.000000 0.0000 0.0000
S 321 352.000000 13702.7400 46.7500
H 0 0.000000 0.0000 0.0000
T 1 1.000000 37.0000 0.0000
648 1194.000000 72612.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2576 3155.500000 156601.2000 9302.4400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 8.000000 399.3200 0.0000
U 0 0.000000 0.0000 0.0000
B 2373 1993.250000 95478.9600 0.0000
P 924 803.250000 38574.4200 38498.6300
D 130 106.000000 4812.1800 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
1631 1554.000000 78314.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5077 4464.500000 217579.1700 38498.6300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.500000 261.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 2347 1928.250000 87149.7100 9.2500
P 1537 1245.000000 53956.1600 53819.0900
D 56 35.000000 1320.8300 9.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4463 4274.500000 208729.7100 0.0000
Other 1 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 8411 7488.250000 351454.6200 53837.5900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2270 1790.083333 77216.8400 92.5000
P 2079 1265.250000 49181.3100 50033.4100
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
2481 2455.000000 147640.1100 0.0000
Other 1 0.836800 62.7600 0.0000
---------------------------------------------------------
Total 6831 5511.170133 274101.0200 50125.9100
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 668 773.250000 30094.5000 157.2500
P 4193 4158.750000 161782.7500 159206.0500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.000000 75.0000 0.0000
T 0 0.000000 0.0000 0.0000
861 2605.250000 131010.7000 131010.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5724 7538.500000 322972.2000 290374.0000