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: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 8 6.000000 222.0000 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 110 332.750000 12228.5000 36.7498
Subtotal (Total Children Is Unduplicated) 114 338.750000 12450.5000 36.7542
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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 12 14.000000 700.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 87 137.029867 10142.2400 74.0148
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 20 39.500000 2842.5000 71.9620
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 18.500000 1337.5000 72.2973
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 62 113.500000 10667.3600 93.9856
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 11 18.500000 1387.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 90 158.500000 8715.7500 54.9890
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 1347 2440.220201 177634.6450 72.7945
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 278 533.993067 39760.2300 74.4583
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 433 809.163200 57858.1400 71.5037
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 82 145.500000 10862.5000 74.6564
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 402 640.133333 47354.4900 73.9760
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 87 157.500000 11762.5000 74.6825
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1370 2371.500000 130616.6300 55.0776
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 244 453.500000 24831.3700 54.7550
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 650 1037.003567 93301.1900 89.9719
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 111 205.500000 15412.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 8 8.000000 2432.0000 304.0000
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 1014.0000 507.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 306.3000 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 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 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 36 36.000000 1800.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 41 42.881489 2174.1000 50.7002
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
Subtotal (Total Children Is Unduplicated) 3211 9442.674724 656200.4750 69.4931
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EI Services,Class #03
CONIP-CONIP-CONSULT, ITDS PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.000000 100.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 1.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 218 2050.790000 102475.2000 49.9686
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 92 564.000000 28200.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 1.000000 10.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 99 924.248600 66021.6760 71.4328
OCCT-97530GT-OT SESSION BY LICENSED OT 64 312.500000 22360.7200 71.5543
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.2000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 9 30.000000 2143.2000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 95 954.900002 68257.4700 71.4813
PHY-97110GT-PT SESSION BY LICENSED PT 53 325.090000 23260.9800 71.5524
PHY-97110HM-PT SESSION BY PT ASST 1 12.000000 685.9200 57.1600
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.750000 196.4600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 245 2482.740006 168815.2960 67.9956
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 160 890.250000 63255.1000 71.0532
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 22.000000 1571.6800 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 6 26.000000 360.8800 13.8800
Subtotal (Total Children Is Unduplicated) 748 8612.018608 548061.1820 63.6391
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Total 18393.443332 1216712.1570 66.1492
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Number of Children (Unduplicated) With at Least One Service 3751
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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 1 1.000000 50.0000 50.0000
D 3 3.500000 204.6900 0.0000
S 193 206.500000 13095.1400 0.0000
H 1677 1783.000000 118441.4200 0.0000
T 0 0.000000 0.0000 0.0000
898 943.250000 56975.7700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2772 2937.250000 188767.0200 50.0000
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
236 273.250000 18492.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 236 273.250000 18492.5000 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 164 154.500000 29261.0500 29337.6000
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
142 147.500000 13305.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 306 302.000000 42566.3000 29337.6000
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 5 8.000000 575.0800 575.0800
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 5 8.000000 575.0800 575.0800
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
978 1511.000000 103180.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 978 1511.000000 103180.8000 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 33 29.261100 2194.5850 2193.9000
D 81 160.000000 11976.0500 0.0000
S 4 3.500000 142.5000 0.0000
H 24 47.000000 3501.0500 0.0000
T 0 0.000000 0.0000 0.0000
156 157.750000 7618.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 298 397.511100 25432.4350 2193.9000
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 1185 1511.000000 97123.4400 98268.8200
D 31 31.000000 1989.6400 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
80 114.500000 7353.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1296 1656.500000 106466.8600 98268.8200
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
1265 2840.500000 192393.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1265 2840.500000 192393.7500 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
3 3.500000 186.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 3.500000 186.0000 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 374 476.750000 31729.7600 21580.1000
D 9 10.000000 533.4900 462.0500
S 12 12.750000 609.5100 0.0000
H 154 191.500000 12912.4100 12.6600
T 1357 1448.250000 82918.6500 57126.2100
475 546.750000 30948.9600 105.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2381 2686.000000 159652.7800 79286.0200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 80 54.250000 2007.2500 0.0000
P 148 127.690000 8766.9000 11977.6400
D 744 762.190000 45223.5460 0.0000
S 10 9.250000 652.2100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1067 1168.010000 74629.1600 0.0000
Other 343 356.750000 23705.4500 0.0000
---------------------------------------------------------
Total 2392 2478.140000 154984.5160 11977.6400
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 164 123.522900 8899.2860 12209.3500
D 738 713.725708 50265.5500 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
887 942.130000 65874.8100 65.8300
Other 168 174.500000 12446.1000 0.0000
---------------------------------------------------------
Total 1957 1953.878608 137485.7460 12275.1800
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 1 0.666667 50.0000 50.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 47 71.000000 4931.8700 0.0000
T 0 0.000000 0.0000 0.0000
151 199.496957 14523.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 199 271.163624 19505.3700 50.0000
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 74 73.500000 2804.2500 2881.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 16 21.500000 795.5000 0.0000
T 0 0.000000 0.0000 0.0000
796 979.750000 63423.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 886 1074.750000 67023.0000 2881.9000