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
Agency Filter:EXT
Payclass Filters:MED
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 72 101.250000 3727.7500 36.8173
Subtotal (Total Children Is Unduplicated) 72 101.250000 3727.7500 36.8173
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.500000 749.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 36.500000 2025.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 45.000000 3375.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 135 258.500000 19348.5000 74.8491
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 11.500000 862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 84 162.000000 12112.5000 74.7685
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 79 153.000000 11475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 104.500000 5799.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 307 567.500000 31496.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 26 40.000000 3000.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 72 131.000000 9825.0000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 7 8.000000 408.4000 51.0500
OCTF-97168TL-OT RE-EVAL EST PLAN CARE 4 4.000000 204.2000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 24.000000 1225.2000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 29 42.000000 2144.1000 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97162TLGT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 13 13.000000 663.6500 51.0500
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 8 8.000000 400.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 27.000000 1378.3500 51.0500
SPCH-92523GT-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 8 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 6 6.000000 306.3000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 4.000000 204.2000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 799 1745.500000 112455.0500 64.4257
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 0.750000 18.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3624 22231.25000 1111436.5000 49.9943
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1090 5226.500000 261312.0000 49.9975
OCCT-97530-OT SESSION BY LICENSED OT 396 1568.500000 112053.6400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 54 200.250000 14305.8600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 154 680.500000 38867.4000 57.1159
OCCT-97530HMGT-OT SESSION BY OT ASST 7 18.500000 1058.2000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 51 196.000000 14002.2400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 23 59.250000 4232.8200 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 3 9.000000 514.8000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 47 208.500000 11926.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 383 1517.500000 108388.7600 71.4259
PHY-97110GT-PT SESSION BY LICENSED PT 83 299.000000 21342.7000 71.3803
PHY-97110HM-PT SESSION BY PT ASST 84 472.250000 26993.8100 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.500000 85.7400 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 30 99.000000 7072.5600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 8 20.500000 1464.5200 71.4400
PHY-97110TLHM-PT SESSION BY PT ASST 12 76.250000 4358.4500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 527 2615.250000 186334.3400 71.2492
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 97 360.500000 25754.1200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 27 177.750000 10167.3000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 136 725.500000 51829.7200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 15 55.000000 3929.2000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 10 25.250000 350.4700 13.8800
Subtotal (Total Children Is Unduplicated) 5606 36844.25000 2017800.1000 54.7657
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Total 38691.000000 2133982.9000 55.1545
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Number of Children (Unduplicated) With at Least One Service 6150
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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 84 85.500000 4487.2100 0.0000
S 6 10.500000 660.7500 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 166 274.000000 17342.2500 0.0000
---------------------------------------------------------
Total 256 370.000000 22490.2100 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 41 33.500000 1239.5000 0.0000
P 16 16.500000 662.5000 442.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1610 5896.250000 297873.6200 0.0000
T 0 0.000000 0.0000 0.0000
54 62.250000 2375.7500 0.0000
Other 2 5.000000 255.2500 51.0500
---------------------------------------------------------
Total 1723 6013.500000 302406.6200 493.9500
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
4599 4481.500000 233845.0200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4599 4481.500000 233845.0200 0.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
1624 5149.250000 287257.8000 0.0000
Other 127 250.500000 17676.0000 412.5000
---------------------------------------------------------
Total 1751 5399.750000 304933.8000 412.5000
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 3 11.000000 742.9600 90.0000
D 0 0.000000 0.0000 0.0000
S 2 7.500000 385.7200 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2847 8951.500000 511097.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2852 8970.000000 512226.3500 90.0000
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
577 1523.500000 94103.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 577 1523.500000 94103.3400 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 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
688 1369.750000 85222.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 688 1369.750000 85222.5800 0.0000
Center 53
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
902 931.250000 48519.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 902 931.250000 48519.9500 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 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
1651 1739.250000 93464.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1651 1739.250000 93464.6900 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2876 2961.500000 180496.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2876 2961.500000 180496.1200 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 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
1361 4931.000000 256274.2200 256274.2200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1361 4931.000000 256274.2200 256274.2200