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:TPIN
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 1 0.500000 18.5000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 8 15.750000 582.7500 37.0000
Subtotal (Total Children Is Unduplicated) 8 16.250000 601.2500 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 19.461866 1459.6399 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 8.007866 600.5900 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.000000 829.0000 63.7692
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 17.000000 1805.7900 106.2229
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 32.000000 1776.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 4 7.500000 416.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 480 781.438801 57505.4100 73.5891
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 94 176.666667 12612.9000 71.3938
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 192 334.623333 24308.5700 72.6446
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 44 75.044666 5279.8200 70.3557
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 158 238.000000 17368.8600 72.9784
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 30 56.000000 3860.0000 68.9286
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 506 813.500000 45105.8000 55.4466
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 101 170.500000 9425.2500 55.2801
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 215 324.189600 29094.0400 89.7439
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 51.500000 3862.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 2 2.000000 608.0000 304.0000
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1060 3142.932799 217381.9699 69.1653
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 0.500000 12.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 77.500000 3875.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.500000 75.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 1 26.500000 1893.1600 71.4400
Subtotal (Total Children Is Unduplicated) 7 108.500000 5968.1600 55.0061
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Total 3267.682799 223951.3799 68.5352
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Number of Children (Unduplicated) With at Least One Service 1065
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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 57 86.000000 5417.0700 5417.0700
D 2 2.000000 130.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 58 83.000000 5571.7500 0.0000
T 8 14.000000 953.9000 953.9000
23 30.500000 2209.5000 0.0000
Other 10 14.500000 1019.2500 0.0000
---------------------------------------------------------
Total 158 230.000000 15301.9700 6370.9700
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 18 34.500000 2512.5000 2512.5000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 34.500000 2512.5000 2512.5000
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
10 15.500000 1123.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10 15.500000 1123.5000 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 55 52.000000 9531.1900 9531.1900
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
28 26.500000 2387.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 83 78.500000 11918.1900 9531.1900
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 1 1.500000 112.5000 112.5000
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 1.500000 112.5000 112.5000
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 7 11.500000 735.7500 735.7500
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
268 339.500000 23513.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 275 351.000000 24248.7500 735.7500
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 27 49.347200 3676.0400 3676.0400
D 4 8.000000 600.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
15 26.000000 1551.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 47 85.347200 5977.0400 3676.0400
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 173 275.000000 17174.3200 17989.7500
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
19 28.500000 1913.2500 0.0000
Other 44 66.500000 4958.2500 0.0000
---------------------------------------------------------
Total 236 370.000000 24045.8200 17989.7500
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
335 650.500000 43610.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 335 650.500000 43610.2500 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 1 1.000000 51.0500 51.0500
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 1.000000 51.0500 51.0500
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 40 76.500000 5294.3100 3832.0800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1911.0000 0.0000
T 130 255.500000 14921.1500 14131.1500
50 95.500000 5809.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 233 453.500000 27935.9800 17963.2300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 2.750000 101.7500 0.0000
P 3 3.920000 247.5000 270.0000
D 17 21.080000 1364.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.500000 262.5000 262.5000
89 140.000000 9310.5000 0.0000
Other 14 18.500000 1290.0000 0.0000
---------------------------------------------------------
Total 128 189.750000 12576.5000 532.5000
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 3 3.480000 261.3900 327.5900
D 11 19.020000 1387.1100 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 63 84.000000 4933.0000 4933.0000
72 114.000000 7851.2500 0.0000
Other 4 7.000000 525.0000 0.0000
---------------------------------------------------------
Total 153 227.500000 14957.7500 5260.5900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 44 88.000000 6600.0000 6600.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
100 147.585599 10704.9199 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 152 251.585599 18504.9199 6600.0000
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 10 5.000000 357.2000 357.2000
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 18 48.000000 2683.0000 2683.0000
261 274.500000 18034.4600 1535.9600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 289 327.500000 21074.6600 4576.1600