CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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 29405 189413.5000 7005257.0000 36.9839
Subtotal (Total Children Is Unduplicated) 29405 189413.5000 7005257.0000 36.9839
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 253 391.000000 29325.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 50 75.500000 5662.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 109 141.500000 10575.0000 74.7350
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 27 36.000000 2700.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 47 77.000000 5775.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 14 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 217 361.000000 27075.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 29 48.500000 3637.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 285 420.000000 23310.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 61 89.500000 4967.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 3278 5281.333333 395902.3400 74.9626
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 698 1201.670133 89941.5100 74.8471
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 1348 1945.500000 145734.6200 74.9086
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 265 428.500000 32137.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 975 1470.000000 110250.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 250 416.500000 31198.5000 74.9064
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 4093 6163.500000 341935.5000 55.4775
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 837 1385.500000 76779.9000 55.4167
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1804 2897.000000 217162.5000 74.9612
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 354 652.000000 48900.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 6 6.000000 353.4600 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 1 1.000000 83.2900 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
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 4 4.000000 204.2000 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 5.000000 255.2500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 209 339.000000 17150.0000 50.5900
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 153.1500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 29.000000 1480.4500 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 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 8974 23916.50347 1625569.3500 67.9685
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 34 85.000000 2125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1059 8530.960000 426522.3000 49.9970
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 369 1838.250000 91912.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 200 1803.000000 128702.9000 71.3826
OCCT-97530GT-OT SESSION BY LICENSED OT 81 330.250000 23582.3800 71.4077
OCCT-97530HM-OT SESSION BY OT ASST 4 11.750000 672.1000 57.2000
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 85 342.500000 24468.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 202 1846.810000 131708.2900 71.3166
PHY-97110GT-PT SESSION BY LICENSED PT 58 216.250000 15448.9000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 10 27.000000 1543.3200 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 11 19.250000 1375.2200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 70 298.250000 21246.1400 71.2360
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 288 2262.410000 161479.0000 71.3748
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 81 204.000000 14559.4800 71.3700
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.000000 57.2000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 41 155.000000 11073.2000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 115 416.000000 29719.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 11 27.000000 374.7600 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 8 9.500000 131.8600 13.8800
Subtotal (Total Children Is Unduplicated) 1895 18442.18000 1087973.4700 58.9938
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Total 231772.183466 9718799.8200 41.9326
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Number of Children (Unduplicated) With at Least One Service 29542
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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 8038 5432.500000 212403.2000 212326.9500
D 33 21.250000 917.3200 0.0000
S 4210 2758.750000 112641.6600 0.0000
H 27914 19681.750000 854178.7400 853491.9200
T 0 0.000000 0.0000 0.0000
19 15.250000 564.2500 0.0000
Other 4 6.750000 382.7500 83.2500
---------------------------------------------------------
Total 40219 27917.000000 1181115.6700 1065902.1200
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 6995 4561.500000 200944.5000 0.0000
---------------------------------------------------------
Total 6995 4561.500000 200944.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 193 151.750000 6177.2100 0.0000
U 0 0.000000 0.0000 0.0000
B 13566 9289.000000 381769.7800 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
210 228.250000 15203.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13971 9669.750000 403177.8900 27.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 330 497.000000 18389.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4812 7000.500000 264047.5000 0.0000
P 11529 17120.250000 663775.0000 657557.7700
D 2 2.000000 112.0000 0.0000
S 3 6.000000 222.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
805 764.500000 50417.6400 0.0000
Other 4 5.500000 203.5000 0.0000
---------------------------------------------------------
Total 17485 25395.750000 997166.6400 657557.7700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 32.250000 1980.5700 0.0000
U 0 0.000000 0.0000 0.0000
B 11388 7475.000000 287201.8400 239822.8000
P 0 0.000000 0.0000 0.0000
D 124 101.500000 4002.2100 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 11545 7612.000000 293304.8700 239822.8000
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
20592 14839.000000 624839.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20595 14842.000000 624950.0000 111.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 122 105.250000 4646.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2221 1673.250000 66719.9500 0.0000
P 13115 11089.500000 464495.7500 466909.9500
D 4 4.500000 166.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 74.0000 0.0000
T 0 0.000000 0.0000 0.0000
93 76.000000 3015.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15556 12950.500000 539117.5000 466909.9500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 52.000000 2202.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 780 810.750000 31496.0000 0.0000
P 16459 17296.750000 689425.2500 689425.2500
D 114 105.000000 3885.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 18.500000 684.5000 573.5000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17398 18283.000000 727692.7500 689998.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 463 351.750000 13336.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 4016 2982.000000 120744.7500 83.2500
P 35005 27161.000000 1125242.0000 1133354.3030
D 156 115.250000 4631.0000 0.0000
S 90 165.000000 11361.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4 12.000000 600.0000 0.0000
Other 51 93.750000 6935.5000 0.0000
---------------------------------------------------------
Total 39785 30880.750000 1282851.0000 1133437.5530
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 8.000000 296.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4180 3074.750000 124872.0800 0.0000
P 2157 1614.000000 63798.0000 63623.7500
D 72 51.750000 2300.2100 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
50 40.750000 2486.3500 0.0000
Other 2 2.000000 126.9400 0.0000
---------------------------------------------------------
Total 6476 4791.250000 193879.5800 63623.7500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 6.000000 450.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1620 1616.500000 72702.0900 25.0000
P 6073 5844.000000 271210.8200 270615.3600
D 0 0.000000 0.0000 0.0000
S 830 879.750000 33664.0800 564.2000
H 59 65.000000 4441.7500 447.7600
T 1 1.000000 37.0000 0.0000
30 35.000000 2153.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8616 8447.250000 384659.3700 271652.3200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 21.500000 1187.3400 0.0000
U 0 0.000000 0.0000 0.0000
B 3396 2917.250000 140618.4000 149.1900
P 11607 10556.460000 487885.0200 487499.8900
D 615 548.000000 32850.6100 0.0000
S 0 0.000000 0.0000 0.0000
H 43 42.500000 2827.1600 50.0000
T 0 0.000000 0.0000 0.0000
716 629.500000 30299.2700 0.0000
Other 207 201.000000 13867.5600 0.0000
---------------------------------------------------------
Total 16615 14916.210000 709535.3600 487699.0800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 18 15.500000 1047.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 3220 2627.750000 122849.1100 157.2500
P 18557 14951.250000 666325.8500 665170.2700
D 584 510.250000 32331.1300 95.8000
S 0 0.000000 0.0000 0.0000
H 51 52.220000 3531.0100 0.0000
T 0 0.000000 0.0000 0.0000
1915 1684.000000 76868.7800 0.0000
Other 312 291.500000 19149.1500 133.2500
---------------------------------------------------------
Total 24657 20132.470000 922102.0800 665556.5700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3362 2656.083333 113470.5400 216.5000
P 13453 10311.250000 415012.9300 429084.3300
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
12 5.750000 212.7500 0.0000
Other 3 2.836800 205.6400 0.0000
---------------------------------------------------------
Total 16831 12977.253466 529001.8600 429300.8300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1232 1388.750000 55176.0000 157.2500
P 15809 16998.000000 673725.0000 667363.5700
D 0 0.000000 0.0000 0.0000
S 1 3.000000 111.0000 111.0000
H 3 4.750000 251.7500 27.7500
T 0 0.000000 0.0000 0.0000
2 0.750000 27.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 17048 18395.500000 729300.7500 667659.5700