CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 10468 31232.75000 1155111.5000 36.9840
Subtotal (Total Children Is Unduplicated) 10468 31232.75000 1155111.5000 36.9840
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 26.000000 1911.0000 73.5000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 52 93.000000 6897.0000 74.1613
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 19 32.000000 2400.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 10 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 15 26.500000 1987.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 35.000000 1942.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 40 69.500000 3857.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 167 314.000000 23550.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 769 1357.500000 101783.2500 74.9785
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 131.500000 9862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 363 574.000000 43000.0000 74.9129
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 86 170.000000 12750.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 208 342.500000 25612.5000 74.7810
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 253 484.500000 26889.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 876 1435.500000 79633.2500 55.4742
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 143 270.500000 20287.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 303 488.500000 36637.5000 75.0000
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161TL-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 2036 5924.500000 403899.6000 68.1745
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 3.000000 75.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 168 648.250000 32412.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 405 1286.750000 64287.5000 49.9611
OCCT-97530-OT SESSION BY LICENSED OT 12 22.000000 1571.6800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 16 48.000000 3429.1200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 9 26.750000 1911.0200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 88 263.250000 18806.5800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 21 36.000000 2571.8400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 2 3.750000 267.9000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 22 81.000000 5786.6400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 63 224.000000 16002.5600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 40.500000 2893.3200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 7.250000 517.9400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 51 218.250000 15591.7800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 93 319.500000 22767.5200 71.2598
Subtotal (Total Children Is Unduplicated) 878 3228.250000 188892.9000 58.5125
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Total 40385.500000 1747904.0000 43.2805
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Number of Children (Unduplicated) With at Least One Service 10775
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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 2 0.500000 18.5000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 0.500000 18.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 165 133.000000 5257.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2699 2031.000000 97209.8500 18.5000
P 110 99.250000 5086.7000 5086.7000
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 2974 2263.250000 107553.8000 5105.2000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 181 308.250000 13093.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 433 632.750000 30350.7500 0.0000
P 669 1120.250000 48129.3000 47025.2900
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 1283 2061.250000 91573.5500 47025.2900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 255 179.000000 6623.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2847 1999.750000 76150.5200 40987.8200
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 3102 2178.750000 82773.5200 40987.8200
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 320 235.750000 8722.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 680 578.250000 25729.0000 0.0000
P 2964 2545.000000 110100.5000 110128.2500
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 3964 3359.000000 144552.2500 110128.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 298 306.500000 11481.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 983 1039.500000 40716.7500 0.0000
P 3050 3446.000000 139336.0000 139273.0200
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 4331 4792.000000 191534.0000 139273.0200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 296 261.750000 10069.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8180 7043.750000 297180.5000 0.0000
P 23 37.500000 2194.9400 883.6900
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 8499 7343.000000 309444.9400 883.6900
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 90 93.000000 5844.0000 0.0000
P 1 1.000000 55.5000 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 91 94.000000 5899.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 222 259.500000 14744.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 1457 1411.250000 61432.2600 111.0000
P 1327 1289.250000 55950.5300 55344.9900
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 3006 2960.000000 132127.6900 55455.9900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2467 2237.000000 107346.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 1756 1520.750000 73390.1800 0.0000
P 1203 1120.750000 53041.5400 53041.5400
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 5426 4878.500000 233778.5600 53041.5400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 63 47.500000 2559.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 1720 1453.750000 64650.8400 87.0000
P 1828 1644.750000 74581.0900 81418.6900
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 3611 3146.000000 141791.5700 81505.6900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4389 3788.500000 161194.6200 0.0000
P 10 9.250000 342.2500 342.2500
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 4399 3797.750000 161536.8700 342.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 509 726.500000 27323.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 666 888.250000 37982.2500 46.2500
P 1493 1896.750000 80013.5000 79431.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2668 3511.500000 145319.2500 79478.0000