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
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
TCM-T1017TL-TARGETED CASE MANAGEMENT 18 36.500000 1350.5000 37.0000
Subtotal (Total Children Is Unduplicated) 18 36.500000 1350.5000 37.0000
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Screening, Eval, and Assessment,Class #02
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 10 12.110800 605.5400 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 22.000000 1650.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 20 33.163200 2487.2400 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 15.500000 1123.5000 72.4839
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 20.500000 1537.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 13 15.500000 1162.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 10.500000 582.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 28.500000 1581.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 60 118.777900 8888.8425 74.8358
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 445 855.818034 64042.3725 74.8318
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 23.500000 1762.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 197 368.500000 27379.7800 74.3006
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 25 48.922200 3669.1650 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 114 209.000000 15675.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 42 82.000000 4551.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 341 647.500000 35650.3200 55.0584
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 54.439100 4082.9325 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 197 331.695200 25226.9500 76.0546
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 17 18.000000 4816.5700 267.5872
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 11 11.000000 600.0000 54.5455
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 714.7000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 546.5500 49.6864
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 991 2972.926434 209543.5625 70.4839
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EI Services,Class #03
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 2 2.000000 100.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 7.000000 350.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 5 4.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 64 306.000000 14975.0000 48.9379
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 93 358.250000 17877.5000 49.9023
OCCT-97530-OT SESSION BY LICENSED OT 17 53.000000 3786.3200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 83 344.250000 24571.7800 71.3777
OCCT-97530TLGT-OT SESSION BY LICENSED OT 9 49.250000 3344.2400 67.9034
PHY-97110-PT SESSION BY LICENSED PT 31 78.750000 5625.9000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 40 181.500000 12966.3600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 8.000000 571.5200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 104 559.750000 38296.6400 68.4174
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 104 390.750000 27885.1800 71.3632
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 6 33.000000 2357.5200 71.4400
Subtotal (Total Children Is Unduplicated) 472 2375.750000 152707.9600 64.2778
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Total 5385.176434 363602.0225 67.5191
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Number of Children (Unduplicated) With at Least One Service 1369
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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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 71.4400 0.0000
H 336 377.000000 24529.1400 0.0000
T 0 0.000000 0.0000 0.0000
133 147.750000 9485.7600 0.0000
Other 2 3.000000 200.0000 0.0000
---------------------------------------------------------
Total 472 528.750000 34286.3400 0.0000
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
546 665.250000 47993.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 546 665.250000 47993.4700 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 4 4.500000 793.8800 793.8800
D 18 25.500000 2982.5000 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
70 79.000000 8146.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 109.000000 11923.1300 793.8800
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
165 285.750000 19377.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 165 285.750000 19377.7500 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 9 9.337100 700.2825 700.2700
D 10 20.000000 1500.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
42 78.000000 5435.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 74 133.337100 9585.2825 700.2700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 51.0500 0.0000
P 188 257.000000 16426.3600 18258.0700
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 2 1.250000 46.4300 71.4400
56 91.500000 6042.3700 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 248 352.250000 22678.7100 18329.5100
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
294 693.500000 47634.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 294 693.500000 47634.7500 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
18 24.000000 1437.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 24.000000 1437.2000 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 66 82.250000 4393.2000 3432.7900
D 107 135.250000 7223.8200 0.0000
S 1 1.000000 71.4400 0.0000
H 202 272.750000 18122.6200 0.0000
T 251 283.000000 17555.2200 11934.0800
56 69.000000 4622.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 683 843.250000 51988.3000 15366.8700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 29 33.750000 1248.7500 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 12 11.750000 839.4200 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
605 671.000000 42970.7300 0.0000
Other 31 30.250000 2010.9800 0.0000
---------------------------------------------------------
Total 677 746.750000 47069.8800 0.0000
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 0 0.000000 0.0000 0.0000
D 3 3.000000 214.3200 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
436 471.250000 33147.7200 0.0000
Other 18 18.000000 1243.0400 0.0000
---------------------------------------------------------
Total 457 492.250000 34605.0800 0.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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 65 88.500000 6294.5400 0.0000
T 0 0.000000 0.0000 0.0000
53 74.589334 5273.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 118 163.089334 11568.3300 0.0000
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 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
242 346.500000 23341.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 243 348.000000 23453.8000 112.5000