CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 11562 41806.00000 1546257.7500 36.9865
Subtotal (Total Children Is Unduplicated) 11562 41806.00000 1546257.7500 36.9865
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 49 89.000000 6675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 24 43.000000 3225.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 27 51.000000 3825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 24 48.000000 3600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 29.500000 1637.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 42 73.000000 4051.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 122 233.000000 17475.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 876 1568.500000 117470.8000 74.8937
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 22 40.000000 3000.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 404 674.500000 50587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 42 77.500000 5812.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 293 484.500000 36300.0000 74.9226
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 187 363.500000 20174.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 956 1564.000000 86774.2500 55.4823
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 106 203.500000 15262.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 330 578.500000 43348.5000 74.9326
OCTH-97165GT-OT 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-97163-PT EVAL HIGH COMPLEXITY 5 6.000000 306.3000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 2 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 89.1000 44.5500
Subtotal (Total Children Is Unduplicated) 2129 6194.500000 423582.4000 68.3804
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 135 696.500000 34825.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 405 1408.750000 70422.5000 49.9894
OCCT-97530-OT SESSION BY LICENSED OT 4 6.000000 428.6400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 20 66.250000 4732.9000 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 2 8.500000 607.2400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 91 337.750000 24128.8600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 18 24.750000 1768.1400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 7 11.500000 821.5600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 6 17.500000 1250.2000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 62 273.250000 19520.9800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 49.500000 3536.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 27.250000 1946.7400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 46 266.000000 19003.0400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 91 416.500000 29733.3200 71.3885
Subtotal (Total Children Is Unduplicated) 856 3610.000000 212725.4000 58.9267
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Total 51610.500000 2182565.5500 42.2892
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Number of Children (Unduplicated) With at Least One Service 11773
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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 2 2.500000 133.2500 50.0000
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 2 2.500000 133.2500 50.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 23 24.250000 910.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 4336 3141.750000 133745.7600 0.0000
P 224 187.750000 8548.8900 8548.8900
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 4583 3353.750000 143204.9000 8548.8900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 109 154.750000 6537.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 1812 3004.250000 118290.0000 64.7500
P 2098 3488.000000 129577.8800 127610.4600
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 4019 6647.000000 254405.6300 127675.2100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 10.750000 439.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 3294 2264.750000 86408.7700 59226.6100
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3310 2275.500000 86848.6700 59226.6100
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 41 40.500000 1611.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 435 346.000000 13363.7500 0.0000
P 3939 3270.000000 139048.5000 139781.1500
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 4415 3656.500000 154023.7500 139781.1500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 10.750000 397.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 151 156.000000 6314.5500 18.5000
P 3520 3928.500000 158323.5500 158823.0500
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 3679 4095.250000 165035.8500 158841.5500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 64.250000 2528.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2871 2230.500000 86846.7500 18.5000
P 8313 6978.000000 294401.5000 293900.4900
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 11264 9272.750000 383776.5000 293918.9900
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 75.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 113 112.000000 6623.0000 0.0000
P 3 4.000000 225.0000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 117 117.000000 6923.0000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 4.250000 187.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 319 350.500000 19675.8500 0.0000
P 2376 2330.250000 103658.5600 103543.3200
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 2699 2685.000000 123521.4100 103543.3200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 22.000000 951.7600 0.0000
U 0 0.000000 0.0000 0.0000
B 2773 2543.000000 123295.2400 0.0000
P 2196 1953.000000 92973.6000 92973.6000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4994 4518.000000 217220.6000 92973.6000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 7.000000 272.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3509 3164.750000 146241.0700 0.0000
P 2959 2589.750000 115603.2100 115584.7100
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 6476 5761.500000 262116.2800 115584.7100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4467 3862.500000 166132.9800 0.0000
P 239 197.500000 7991.5000 7852.7620
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 4706 4060.000000 174124.4800 7852.7620
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 7.000000 276.2200 0.0000
U 0 0.000000 0.0000 0.0000
B 160 190.500000 7889.0400 0.0000
P 3896 4968.250000 203065.9700 200491.1800
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 4063 5165.750000 211231.2300 200491.1800