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
Agency Filter:EIP DEI DEIP
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 11559 35374.00000 1307634.1000 36.9660
Subtotal (Total Children Is Unduplicated) 11559 35374.00000 1307634.1000 36.9660
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 26.000000 1950.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 35 60.000000 4500.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 36 54.500000 4087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 21.500000 1612.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 11 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 19 36.500000 2025.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 47 76.500000 4245.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 299 567.000000 42525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 650 1145.500000 85873.5000 74.9660
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 66 115.000000 8625.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 424 667.000000 50025.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 196.500000 14737.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 214 382.000000 28581.7500 74.8213
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 314 606.000000 33633.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 963 1665.000000 92407.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 246.000000 18450.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 286 491.500000 36667.5000 74.6033
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 1365.7200 71.8800
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
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) 2121 6467.500000 437318.2900 67.6178
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 3.000000 214.3200 71.4400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 250 1024.000000 51125.0000 49.9268
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 374 1148.250000 57412.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 13 23.000000 1643.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 5 7.500000 535.8000 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 59 172.750000 12341.2600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 103 315.250000 22521.4600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 17 41.750000 2982.6200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 4 4.000000 285.7600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 85 297.000000 21217.6800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 71 160.250000 11448.2600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 78.250000 5590.1800 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 112 376.750000 26914.9800 71.4399
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 117 434.250000 31022.8200 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 978 4098.500000 245918.5200 60.0021
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Total 45940.000000 1990870.9100 43.3363
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Number of Children (Unduplicated) With at Least One Service 11927
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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 574 498.500000 27830.4800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 1.750000 64.7500 0.0000
Other 3 3.250000 120.2500 0.0000
---------------------------------------------------------
Total 579 503.500000 28015.4800 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 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 1397 945.750000 40004.2500 0.0000
---------------------------------------------------------
Total 1398 946.000000 40013.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.500000 126.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 1890 1603.750000 79072.2700 0.0000
P 81 76.250000 3988.3400 3988.3400
D 5 6.250000 373.5000 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
22 21.500000 1339.1300 0.0000
Other 108 118.500000 4877.5000 0.0000
---------------------------------------------------------
Total 2109 1828.750000 89777.6800 3988.3400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 13.000000 858.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2699 4263.500000 169370.4400 0.0000
P 643 1122.250000 41551.0000 41551.0000
D 31 36.750000 1359.7500 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
283 360.250000 21815.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3667 5795.750000 234955.1400 41551.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 53 34.500000 1276.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2191 1398.750000 51753.7500 14420.7500
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
16 8.250000 305.2500 0.0000
Other 69 52.000000 1924.0000 0.0000
---------------------------------------------------------
Total 2329 1493.500000 55259.5000 14420.7500
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
4569 3770.000000 165649.0000 0.0000
Other 2 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 4571 3771.000000 165686.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 90 78.500000 2904.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 906 840.250000 39351.0000 0.0000
P 1468 1263.500000 53700.7500 53596.9000
D 0 0.000000 0.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.2500 0.0000
9 5.750000 212.7500 0.0000
Other 50 24.500000 906.5000 0.0000
---------------------------------------------------------
Total 2525 2213.000000 97094.0000 53596.9000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1054 1108.750000 44255.2600 37.0000
P 3172 3190.250000 125904.1300 125903.7550
D 11 11.000000 550.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 7.750000 364.7500 729.5000
1 0.500000 18.5000 0.0000
Other 41 51.250000 1896.2500 0.0000
---------------------------------------------------------
Total 4298 4378.000000 173303.3900 126670.2550
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 66 72.500000 3365.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8403 7226.250000 302447.2500 0.0000
P 70 61.000000 2294.0000 0.0000
D 19 17.500000 723.5000 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
242 143.250000 5432.2500 0.0000
Other 1144 902.000000 35921.5000 0.0000
---------------------------------------------------------
Total 9944 8422.500000 350184.0000 0.0000
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
18 32.250000 2082.6900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 32.250000 2082.6900 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 43.000000 2416.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 563 615.000000 30038.0800 37.0000
P 1540 1593.750000 71741.6200 71503.5800
D 0 0.000000 0.0000 0.0000
S 29 35.250000 1540.1300 59.2500
H 2 1.250000 59.2500 9.2500
T 0 0.000000 0.0000 0.0000
31 35.750000 1426.5000 0.0000
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 2211 2326.750000 107323.8500 71609.0800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 35.000000 1415.8800 0.0000
U 0 0.000000 0.0000 0.0000
B 1505 1385.750000 70465.6100 9.2500
P 658 621.500000 30270.2700 30270.3100
D 28 26.750000 1893.8000 0.0000
S 94 67.750000 3001.9500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1084 991.500000 49474.0200 0.0000
Other 299 223.750000 10478.0600 0.0000
---------------------------------------------------------
Total 3704 3352.000000 166999.5900 30279.5600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 108 142.250000 8652.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2596 2242.000000 101147.4000 0.0000
P 849 793.250000 36881.2900 36881.2900
D 8 6.750000 413.3400 0.0000
S 49 53.500000 3843.9800 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
1702 1547.500000 71044.7400 0.0000
Other 144 104.000000 4409.4000 155.6900
---------------------------------------------------------
Total 5457 4890.250000 226463.5900 37036.9800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2723 2433.750000 104601.1500 0.0000
P 1 0.250000 9.2500 9.2500
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
14 19.250000 1012.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2738 2453.250000 105622.6500 9.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 850 1302.500000 53915.7500 0.0000
P 1683 2215.750000 93559.7500 101802.4700
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 5 4.250000 233.2500 59.6000
3 7.000000 233.1000 0.0000
Other 2 4.000000 148.0000 0.0000
---------------------------------------------------------
Total 2543 3533.500000 148089.8500 101862.0700