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
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 6 4.500000 166.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 56 100.750000 3727.7500 37.0000
Subtotal (Total Children Is Unduplicated) 60 105.250000 3894.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 3.750000 187.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 10 12.000000 600.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 8 11.500000 862.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 8.500000 637.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.500000 187.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 10 16.500000 1237.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 13.000000 721.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 6 10.500000 582.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 48 80.000000 6000.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 272 522.493067 38897.7300 74.4464
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 11.000000 825.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 81 144.000000 10750.0000 74.6528
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 17 26.000000 1950.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 85 155.000000 11575.0000 74.6774
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 49 73.500000 4079.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 240 446.000000 24470.6200 54.8669
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 10 16.500000 1237.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 197.500000 14812.5000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 5.881489 300.2500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 605 1785.124556 121702.2000 68.1757
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 71.750000 3587.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 89 518.500000 25925.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 5.500000 392.9200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 60 274.000000 19610.2800 71.5704
OCCT-97530TLGT-OT SESSION BY LICENSED OT 9 30.000000 2143.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 16.750000 1196.6200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 53 288.090000 20617.7000 71.5669
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.750000 196.4600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 73.250000 5232.9800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 156 831.500000 59058.0000 71.0259
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
Subtotal (Total Children Is Unduplicated) 366 2134.090000 139532.3400 65.3826
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Total 4024.464556 265128.7900 65.8793
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Number of Children (Unduplicated) With at Least One Service 961
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 2 2.000000 142.8800 0.0000
H 549 559.250000 35448.7200 0.0000
T 0 0.000000 0.0000 0.0000
272 289.000000 18021.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 823 850.250000 53612.6100 0.0000
Center 03
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
94 104.750000 7183.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 94 104.750000 7183.9800 0.0000
Center 04
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
33 40.250000 2931.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 33 40.250000 2931.7500 0.0000
Center 05
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 4 6.000000 432.2000 432.2000
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 4 6.000000 432.2000 432.2000
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
187 285.000000 19643.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 187 285.000000 19643.5500 0.0000
Center 07
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 1 1.250000 46.2500 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
87 102.250000 5151.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 111.500000 5797.5000 0.0000
Center 09
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 115 153.500000 9893.4600 10121.3600
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
64 98.500000 6287.0100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 179 252.000000 16180.4700 10121.3600
Center 10
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
238 520.000000 35889.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 238 520.000000 35889.7500 0.0000
Center 51
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
1 1.500000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.500000 55.5000 0.0000
Center 52
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 17 27.500000 1695.5100 1509.6300
D 0 0.000000 0.0000 0.0000
S 4 4.000000 285.7600 0.0000
H 46 51.750000 3544.0200 0.0000
T 197 202.250000 13259.7000 8288.7500
163 196.500000 12793.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 427 482.000000 31578.6800 9798.3800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 5.750000 212.7500 0.0000
P 11 10.340000 739.5200 1182.3200
D 21 21.000000 1157.2000 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
477 515.750000 33217.0100 0.0000
Other 27 26.500000 1893.1600 0.0000
---------------------------------------------------------
Total 549 579.340000 37219.6400 1182.3200
Center 54
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 28 28.250000 2018.1800 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
447 462.250000 32525.8200 0.0000
Other 28 27.000000 1928.8800 0.0000
---------------------------------------------------------
Total 503 517.500000 36472.8800 0.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 42 64.000000 4437.9400 0.0000
T 0 0.000000 0.0000 0.0000
44 40.374556 2839.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 104.374556 7277.2800 0.0000
Center 57
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 7 4.750000 175.7500 175.7500
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
125 165.250000 10677.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 132 170.000000 10853.0000 175.7500