CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 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 26308 165225.7500 6110152.5000 36.9806
Subtotal (Total Children Is Unduplicated) 26308 165225.7500 6110152.5000 36.9806
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 261 415.500000 31162.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 38 64.000000 4800.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 105 140.500000 10500.0000 74.7331
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 45 72.500000 5437.5000 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 154 219.500000 16425.0000 74.8292
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 16 28.500000 2137.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 263 390.000000 21645.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 32 49.000000 2719.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3267 5302.500000 397575.0000 74.9788
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 600 1069.333333 80092.7500 74.8997
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1235 1768.000000 132533.2500 74.9622
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 175 288.000000 21600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 848 1258.000000 94350.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 219 364.000000 27300.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3656 5456.500000 302669.2500 55.4695
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 639 1090.000000 60389.5000 55.4032
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1384 2220.500000 166425.0000 74.9493
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 200 352.000000 26400.0000 75.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 12 13.000000 663.6500 51.0500
SCREEN-T1023-SCREENING 194 322.000000 16300.0000 50.6211
SPCH-92522-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 18.000000 918.9000 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
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 8104 20956.83333 1425632.0000 68.0271
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 34 84.000000 2100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 957 6951.210000 347534.8000 49.9963
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 260 1135.000000 56750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 153 964.500000 68875.4000 71.4105
OCCT-97530GT-OT SESSION BY LICENSED OT 49 120.500000 8608.5200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 8 27.500000 1431.4000 52.0509
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 11 17.000000 1214.4800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 74 227.000000 16216.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 161 1113.000000 79162.2000 71.1251
PHY-97110GT-PT SESSION BY LICENSED PT 32 80.500000 5750.9200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 12 59.000000 3372.4400 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 11 15.250000 1089.4600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 63 201.500000 14334.3200 71.1381
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 219 1508.750000 107697.5400 71.3820
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 58 99.750000 7111.8600 71.2968
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 41 148.000000 10573.1200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 96 300.500000 21467.7200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 27.7600 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 5 5.500000 76.3400 13.8800
Subtotal (Total Children Is Unduplicated) 1637 13062.46000 753509.5600 57.6851
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Total 199245.043333 8289294.0600 41.6035
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Number of Children (Unduplicated) With at Least One Service 26493
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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 8346 5692.500000 222522.2000 222438.4500
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 8347 5693.250000 222549.9500 222438.4500
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 200 161.500000 6650.9600 0.0000
U 0 0.000000 0.0000 0.0000
B 14461 10188.500000 422794.2800 0.0000
P 2 0.750000 27.7500 27.7500
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 14663 10350.750000 429472.9900 27.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 503 635.250000 23504.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 5094 7364.000000 278608.0000 37.0000
P 12940 19305.500000 761688.0100 731164.1500
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 18537 27304.750000 1063800.2600 731201.1500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 30 34.750000 2168.0700 0.0000
U 0 0.000000 0.0000 0.0000
B 11884 7918.250000 304370.8400 254953.8000
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 11915 7955.000000 306638.9100 255053.8000
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 3 3.000000 111.0000 111.0000
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 3 3.000000 111.0000 111.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 133 119.750000 5258.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2350 1786.250000 71363.7000 0.0000
P 13664 11756.250000 495685.2500 497509.4500
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 16147 13662.250000 572307.7000 497509.4500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 53.000000 2239.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 814 876.000000 34171.7500 0.0000
P 17279 18648.000000 753598.7500 753598.7500
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 18135 19577.000000 790009.5000 753598.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 492 377.000000 14271.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4181 3156.750000 128442.5000 83.2500
P 36717 29094.750000 1214678.7700 1221198.6330
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 41390 32628.500000 1357392.2700 1221281.8830
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4348 3212.250000 130410.8300 0.0000
P 2263 1712.250000 67757.2500 67583.0000
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 6626 4932.500000 198464.0800 67583.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1669 1684.750000 76023.3400 175.0000
P 6418 6341.500000 295322.8200 294806.4100
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 8090 8032.250000 371796.1600 294981.4100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 30.500000 1548.0900 0.0000
U 0 0.000000 0.0000 0.0000
B 3617 3156.750000 151650.4000 149.1900
P 12547 11551.710000 533301.5200 534595.8900
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 16203 14738.960000 686500.0100 534745.0800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 15.500000 1047.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 3473 2885.000000 134655.1100 157.2500
P 20340 16741.500000 746536.6000 744987.9200
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 23831 19642.000000 882238.7600 745145.1700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3832 3274.833333 143670.0400 281.2500
P 14783 11817.250000 481560.9300 500350.3800
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 18615 15092.083333 625230.9700 500631.6300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1289 1468.250000 58684.0000 157.2500
P 16597 18164.250000 724088.2500 717545.0200
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 17887 19632.750000 782781.5000 717702.2700