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
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 857 3595.250000 132830.0000 36.9460
Subtotal (Total Children Is Unduplicated) 857 3595.250000 132830.0000 36.9460
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.500000 233.2500 66.6429
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 40.500000 3037.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 5 9.000000 499.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 32.000000 1776.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 34 55.000000 4125.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 344 581.000000 43575.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 28.500000 2137.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 147 237.500000 17812.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 26.000000 1950.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 137 223.500000 16762.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 50 88.500000 4911.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 392 641.500000 35603.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 40.500000 3037.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 110 168.500000 12637.5000 75.0000
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 684 2209.000000 150586.2500 68.1694
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 7.000000 350.0000 50.0000
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.500000 178.6000 71.4400
Subtotal (Total Children Is Unduplicated) 2 9.500000 528.6000 55.6421
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Total 5813.750000 283944.8500 48.8402
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Number of Children (Unduplicated) With at Least One Service 886
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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 273 231.250000 10662.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 3.000000 195.7500 0.0000
Other 44 51.500000 3208.5000 0.0000
---------------------------------------------------------
Total 319 285.750000 14066.2500 0.0000
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 125 132.250000 6581.2500 0.0000
---------------------------------------------------------
Total 125 132.250000 6581.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.750000 510.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 87 109.500000 5861.2500 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 94 120.250000 6372.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 18.000000 1118.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 35.750000 1925.7500 0.0000
P 44 64.750000 2809.7500 2809.7500
D 1 1.000000 75.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 7.000000 350.0000 0.0000
T 0 0.000000 0.0000 0.0000
98 176.000000 7162.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 191 302.500000 13441.7500 2809.7500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.250000 527.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 183 183.750000 7045.7500 4121.7500
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 195 198.000000 7573.0000 4121.7500
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
441 501.500000 24994.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 441 501.500000 24994.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 14.750000 545.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 31 44.250000 2165.2500 0.0000
P 131 176.500000 8648.5000 8648.5000
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
3 3.000000 187.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 173 238.500000 11546.5000 8648.5000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 23.000000 888.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 115.250000 4723.0000 0.0000
P 193 327.000000 14874.2500 14892.7500
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
20 39.500000 2962.5000 0.0000
Other 93 176.500000 12535.5000 0.0000
---------------------------------------------------------
Total 389 681.250000 35983.2500 14892.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 8.250000 342.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 346 421.500000 19707.7500 0.0000
P 3 6.000000 411.0000 102.7500
D 1 0.500000 18.5000 0.0000
S 40 71.500000 4992.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 2.500000 178.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 397 510.250000 25650.1000 102.7500
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 23.000000 1471.5000 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
8 7.000000 335.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 30.000000 1806.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 10.000000 711.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 88.750000 3783.5000 0.0000
P 54 75.250000 3190.0000 3190.0000
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
10 18.750000 1104.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 135 192.750000 8789.2500 3190.0000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 150 153.500000 7110.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 194 196.000000 9153.2500 0.0000
P 110 127.250000 6250.5000 6250.5000
D 0 0.000000 0.0000 0.0000
S 7 10.000000 750.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
23 38.500000 2458.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 484 525.250000 25722.7500 6250.5000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 130 136.000000 6113.0000 0.0000
P 141 191.750000 9027.7500 9166.9000
D 0 0.000000 0.0000 0.0000
S 5 7.500000 562.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
250 317.750000 15651.5000 0.0000
Other 3 6.000000 355.0000 145.0000
---------------------------------------------------------
Total 529 659.000000 31709.7500 9311.9000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 589 728.000000 34339.0000 0.0000
P 1 1.000000 37.0000 37.0000
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
87 174.000000 11763.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 677 903.000000 46139.0000 37.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 63 108.250000 4306.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 88 139.000000 6530.2500 0.0000
P 175 280.500000 12520.2500 12411.7500
D 2 1.500000 55.5000 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
2 4.250000 157.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 330 533.500000 23569.5000 12411.7500