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:TPIN
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 8 20.250000 749.2500 37.0000
Subtotal (Total Children Is Unduplicated) 8 20.250000 749.2500 37.0000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 4.000000 200.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.500000 487.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 18 34.000000 2550.0000 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 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.500000 187.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 5.500000 305.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 32.500000 1753.7500 53.9615
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 172 354.500000 26355.6500 74.3460
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 262 508.672840 37875.4630 74.4594
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 51 104.500000 7497.5000 71.7464
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 101 192.000000 14360.0000 74.7917
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 63 121.000000 9075.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 71 131.500000 9470.7000 72.0205
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 102 206.500000 11460.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 284 546.000000 29941.2000 54.8374
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 70 143.500000 10762.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 180.269100 13520.1825 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 4256.0000 304.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 31.0500 31.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 5 6.000000 250.0000 41.6667
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 235.2500 47.0500
Subtotal (Total Children Is Unduplicated) 850 2647.441940 183637.8455 69.3643
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3 2.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 78 345.500000 17185.0000 49.7395
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 40 123.500000 6175.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 108.250000 7733.3800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 49 123.500000 8782.8400 71.1161
OCCT-97530TL-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 3 9.750000 696.5400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 48 185.250000 13269.9800 71.6328
PHY-97110GT-PT SESSION BY LICENSED PT 32 89.500000 6393.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 3.000000 214.3200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 145 613.250000 42035.1800 68.5449
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 95 326.500000 23037.6000 70.5593
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
Subtotal (Total Children Is Unduplicated) 411 1935.750000 125850.5400 65.0138
-----------------------------------------------------------------------------------------------------------------------
Total 4603.441940 310237.6355 67.3925
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1199
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 50.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 71.4400 0.0000
H 119 131.750000 8539.2600 0.0000
T 0 0.000000 0.0000 0.0000
27 37.000000 2544.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 148 170.750000 11205.1000 0.0000
Center 03
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
445 572.500000 41675.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 445 572.500000 41675.9500 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 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
59 64.500000 7955.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 59 64.500000 7955.7500 0.0000
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
186 336.500000 23004.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 186 336.500000 23004.7500 0.0000
Center 07
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 4 4.941940 370.6455 370.6400
D 3 6.000000 450.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 14.000000 1050.0000 0.0000
T 0 0.000000 0.0000 0.0000
29 58.000000 4350.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 43 82.941940 6220.6455 370.6400
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 68 112.000000 5936.0800 6199.5600
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 3 6.000000 333.0000 0.0000
116 183.250000 11520.0800 225.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 187 301.250000 17789.1600 6424.5600
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 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
329 712.000000 48568.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 329 712.000000 48568.5000 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
9 20.000000 1368.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 20.000000 1368.0400 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 50 70.500000 3497.0600 2410.8100
D 169 185.250000 9488.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 88 111.500000 6922.5000 0.0000
T 204 225.750000 13041.6500 8812.0500
114 157.750000 10757.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 625 750.750000 43706.9800 11222.8600
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
578 619.000000 41493.0900 0.0000
Other 8 8.000000 571.5200 0.0000
---------------------------------------------------------
Total 586 627.000000 42064.6100 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 5 8.000000 592.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
472 502.000000 35300.7400 0.0000
Other 10 10.000000 714.4000 0.0000
---------------------------------------------------------
Total 487 520.000000 36608.0200 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 72 114.000000 8143.2000 0.0000
T 0 0.000000 0.0000 0.0000
48 50.750000 3661.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 120 164.750000 11804.3800 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 2 3.000000 195.7500 400.0000
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
149 277.500000 18070.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 151 280.500000 18265.7500 400.0000