CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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 11290 36406.00000 1346555.0000 36.9872
Subtotal (Total Children Is Unduplicated) 11290 36406.00000 1346555.0000 36.9872
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 13 27.500000 2062.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 39 67.500000 5062.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 19.000000 1425.0000 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 10 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 15 25.500000 1912.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 42.500000 2358.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 37 66.000000 3663.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 236 451.000000 33775.0000 74.8891
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 835 1449.500000 108644.2500 74.9529
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 85 160.500000 12037.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 284 465.500000 34912.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 117 218.500000 16387.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 169 290.500000 21787.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 336 641.000000 35575.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 851 1423.500000 79004.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 151 278.500000 20887.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 246 422.500000 31687.5000 75.0000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 16 17.000000 850.0000 50.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
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 9 10.000000 510.5000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 2093 6121.000000 415535.5500 67.8869
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 207 753.250000 37662.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 342 1154.750000 57737.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 35.750000 2553.9800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 7 13.500000 964.4400 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 24 55.250000 3929.2000 71.1167
OCCT-97530TLGT-OT SESSION BY LICENSED OT 87 235.250000 16806.2600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 20 44.750000 3196.9400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.500000 321.4800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 29 86.000000 6143.8400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 58 187.250000 13377.1400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 36.500000 2607.5600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 285.7600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 73 263.500000 18824.4400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 131 457.000000 32532.9600 71.1881
Subtotal (Total Children Is Unduplicated) 869 3333.250000 196994.0000 59.0997
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Total 45860.250000 1959084.5500 42.7186
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Number of Children (Unduplicated) With at Least One Service 11533
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Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2712 2295.250000 110927.9700 0.0000
P 1 1.000000 71.4400 71.4400
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 2716 2297.000000 111027.1600 71.4400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2220 3553.500000 139602.5000 0.0000
P 900 1568.000000 62282.0000 61718.8000
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 3120 5121.500000 201884.5000 61718.8000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2845 1997.500000 75357.2100 37282.3200
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 2845 1997.500000 75357.2100 37282.3200
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 68 49.500000 1831.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 886 736.750000 31401.7500 0.0000
P 2804 2533.250000 109462.5000 109203.1000
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 3758 3319.500000 142695.7500 109203.1000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 777 811.750000 32125.6300 0.0000
P 3556 3827.500000 153878.3700 153819.1200
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 4334 4640.500000 186050.2500 153819.1200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.000000 444.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9146 8368.750000 356136.5000 0.0000
P 9 21.500000 1511.4600 281.2000
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 9168 8402.250000 358091.9600 281.2000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 22.000000 1445.2500 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 19 22.000000 1445.2500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 630 695.000000 34442.5300 0.0000
P 2335 2364.000000 103509.4000 102800.1100
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 2966 3059.500000 137970.4300 102800.1100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 31.000000 1550.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2434 2211.250000 106224.9400 74.0000
P 1775 1598.250000 76549.4100 76192.2100
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 4240 3840.500000 184324.3500 76266.2100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3043 2667.000000 118460.7600 0.0000
P 2594 2222.000000 98642.3900 98570.9520
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 5637 4889.000000 217103.1500 98570.9520
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 4249 3552.000000 150145.7900 0.0000
P 2 0.500000 18.5000 18.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4251 3552.500000 150164.2900 18.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 11.000000 407.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3263 4398.000000 179097.2500 0.0000
P 247 309.500000 13466.0000 13299.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3514 4718.500000 192970.2500 13299.5000