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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 886 4100.000000 151700.0000 37.0000
Subtotal (Total Children Is Unduplicated) 886 4100.000000 151700.0000 37.0000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 22.500000 1687.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 18.000000 1350.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 10 16.500000 1237.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 19.000000 1054.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 36.500000 2737.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 311 522.500000 39187.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 170 274.500000 20587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 137 231.500000 17362.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 29 53.000000 2941.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 394 639.500000 35492.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 15 30.000000 2250.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 194.000000 14550.0000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 654 2144.500000 146275.2500 68.2095
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.750000 125.0200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 2 4.500000 321.4800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 142.8800 71.4400
Subtotal (Total Children Is Unduplicated) 4 12.250000 853.7000 69.6898
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Total 6256.750000 298828.9500 47.7611
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Number of Children (Unduplicated) With at Least One Service 918
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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 1.500000 83.2500 0.0000
D 2 3.000000 166.5000 0.0000
S 399 373.500000 17700.2500 0.0000
H 262 204.000000 8560.7500 8560.7500
T 0 0.000000 0.0000 0.0000
1 0.250000 9.2500 0.0000
Other 74 87.750000 5633.0000 972.0000
---------------------------------------------------------
Total 739 670.000000 32153.0000 9532.7500
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 113 111.500000 5394.7500 0.0000
---------------------------------------------------------
Total 113 111.500000 5394.7500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 121 134.750000 5884.5000 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
1 1.500000 83.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 123 137.000000 5995.5000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 4.750000 288.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 62 107.750000 4373.0000 0.0000
P 85 149.250000 5616.7500 5513.7400
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
51 55.500000 3563.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 203 317.250000 13842.0000 5513.7400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 255 250.250000 9715.2500 6581.2500
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 255 250.250000 9715.2500 6581.2500
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
383 387.500000 18253.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 383 387.500000 18253.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 92.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 18.500000 684.5000 0.0000
P 205 257.000000 11958.0000 11958.0000
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 231 278.000000 12735.0000 11958.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 13.500000 621.2500 0.0000
P 172 290.250000 13165.7500 13165.7500
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
23 45.500000 3373.5000 0.0000
Other 55 109.500000 7832.2500 0.0000
---------------------------------------------------------
Total 259 458.750000 24992.7500 13165.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.750000 585.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 149 168.000000 7095.7500 0.0000
P 471 547.000000 26131.0000 26131.0000
D 1 2.000000 111.0000 0.0000
S 30 56.500000 3837.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6 11.250000 782.2600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 670 797.500000 38543.5100 26131.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 22.500000 1356.0000 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
20 19.750000 957.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 43 42.250000 2313.7500 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 9 13.500000 887.7500 0.0000
P 66 108.750000 5224.5000 5224.5000
D 0 0.000000 0.0000 0.0000
S 10 11.000000 444.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
9 18.000000 1155.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 94 151.250000 7711.2500 5224.5000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 6.500000 240.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 128 145.000000 7653.5000 0.0000
P 85 92.750000 4263.2500 4263.2500
D 44 40.000000 1480.0000 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
13 21.500000 1316.4400 0.0000
Other 1 0.250000 9.2500 9.2500
---------------------------------------------------------
Total 276 306.000000 14962.9400 4272.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 346 395.250000 18903.7500 0.0000
P 169 193.750000 8573.7500 8573.7500
D 18 23.750000 954.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.250000 9.2500 9.2500
T 0 0.000000 0.0000 0.0000
39 71.500000 4416.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 573 684.500000 32858.2500 8583.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 599 695.250000 31802.2500 0.0000
P 32 38.500000 1652.5000 1615.5000
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
103 206.000000 14397.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 734 939.750000 47851.7500 1615.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 14 22.750000 1164.7500 0.0000
P 435 702.000000 30322.2500 29609.1600
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 450 725.250000 31505.5000 29609.1600