CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 9414 30700.00000 1134796.0000 36.9640
Subtotal (Total Children Is Unduplicated) 9414 30700.00000 1134796.0000 36.9640
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 37 68.500000 5137.5000 75.0000
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 11 21.000000 1575.0000 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 12 21.000000 1575.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 17.500000 1312.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 31.000000 1720.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 69.500000 3857.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 278 527.000000 39525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 587 1043.000000 78195.7500 74.9720
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 91.500000 6862.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 297 474.500000 35509.5000 74.8356
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 101 194.000000 14550.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 160 276.500000 20669.2500 74.7532
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 308 600.500000 33327.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 829 1459.500000 81002.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 141 268.500000 20137.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 243 428.500000 31942.5000 74.5449
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 1006.3200 71.8800
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 2.000000 102.1000 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 12 12.000000 600.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 7.000000 357.3500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 1878 5690.000000 383355.2200 67.3735
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 209 908.000000 45325.0000 49.9174
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 295 706.500000 35325.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 6.000000 428.6400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 5.500000 392.9200 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 38 86.250000 6161.7000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 86 223.750000 15984.7000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 35.250000 2518.2600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 285.7600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 59 155.000000 11073.2000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 58 112.500000 8037.0000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 47.500000 3393.4000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 8.500000 607.2400 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 87 287.250000 20521.1000 71.4399
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 103 299.500000 21396.2800 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
Subtotal (Total Children Is Unduplicated) 818 2886.500000 171464.0800 59.4021
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Total 39276.500000 1689615.3000 43.0185
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Number of Children (Unduplicated) With at Least One Service 9686
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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 1 0.250000 9.2500 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 1 0.250000 9.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.250000 154.6900 0.0000
U 0 0.000000 0.0000 0.0000
B 1976 1732.250000 86144.0200 0.0000
P 81 76.250000 3988.3400 3988.3400
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 2061 1811.750000 90287.0500 3988.3400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 17.000000 1044.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2921 4558.750000 181516.5700 0.0000
P 662 1154.250000 42752.2200 42716.5000
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 3596 5730.000000 225312.7900 42716.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 40.250000 1489.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2369 1557.250000 57618.2500 16372.5000
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 2427 1597.500000 59107.5000 16372.5000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 93 84.750000 3135.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 993 966.750000 45570.5000 0.0000
P 1549 1374.250000 58848.5000 58716.9000
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 2635 2425.750000 107554.7500 58716.9000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1094 1172.000000 47238.7600 37.0000
P 3350 3466.750000 138566.8800 138566.5050
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 4454 4647.250000 186120.1400 138603.5050
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 66 72.500000 3365.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8677 7560.500000 318240.7500 0.0000
P 71 63.250000 2377.2500 16.6500
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 8814 7696.250000 323983.5000 16.6500
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 43.000000 2416.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 576 633.750000 31148.8300 37.0000
P 1603 1695.250000 76555.1200 76317.0800
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 2221 2372.000000 110120.4700 76354.0800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 35.000000 1415.8800 0.0000
U 0 0.000000 0.0000 0.0000
B 1668 1578.500000 79670.1100 9.2500
P 743 728.500000 34954.0200 34954.0600
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 2447 2342.000000 116040.0100 34963.3100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 121 168.250000 10390.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2823 2491.750000 111546.1500 0.0000
P 925 905.000000 42533.0400 42533.0400
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 3869 3565.000000 164469.1900 42533.0400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3119 2997.250000 132240.1500 0.0000
P 2 2.250000 159.2500 159.2500
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 3121 2999.500000 132399.4000 159.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 962 1516.750000 63268.2500 0.0000
P 1880 2572.500000 110943.0000 119185.7200
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 2842 4089.250000 174211.2500 119185.7200