CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 8961 30382.25000 1123689.4900 36.9851
Subtotal (Total Children Is Unduplicated) 8961 30382.25000 1123689.4900 36.9851
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 27.000000 2025.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 36 65.000000 4875.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 14.000000 1050.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 37 67.500000 3746.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 386 727.500000 54562.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 621 1110.000000 83211.0000 74.9649
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 96 176.500000 13237.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 334 512.500000 38437.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 115 205.500000 15412.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 154 263.000000 19686.0000 74.8517
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 353 674.000000 37407.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 919 1616.500000 89715.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 167 297.000000 22275.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 194 325.500000 24412.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 25 25.000000 1797.0000 71.8800
OCTH-97165-OT EVAL LOW COMPLEXITY 3 6.000000 306.3000 51.0500
OCTH-97165TLGT-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 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 32 32.000000 1600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92521TL-EVAL OF SPEECH FLUENCY 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 5 5.000000 255.2500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 6.000000 315.4200 52.5700
Subtotal (Total Children Is Unduplicated) 2083 6251.500000 420702.9700 67.2963
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 259 1013.000000 50612.5000 49.9630
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 254 529.750000 26487.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 9.500000 678.6800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 4 3.500000 250.0400 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 9 18.250000 1303.7800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 13 40.000000 2857.6000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 14.750000 1053.7400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 13 33.500000 2393.2400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 9 13.500000 964.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 53.500000 3822.0400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 8.750000 625.1000 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 49 235.000000 16788.4000 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 25 57.000000 4072.0800 71.4400
Subtotal (Total Children Is Unduplicated) 592 2031.000000 111980.5800 55.1357
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Total 38664.750000 1656373.0400 42.8394
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Number of Children (Unduplicated) With at Least One Service 9443
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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 6 6.000000 428.6400 428.6400
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 6 6.000000 428.6400 428.6400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 25.000000 925.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3872 3008.250000 132823.5200 0.0000
P 1 2.000000 150.0000 150.0000
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 3908 3035.250000 133898.5200 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 36.750000 1595.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1271 1998.750000 82955.2500 0.0000
P 2039 3440.000000 136002.0400 134914.1500
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 3341 5475.500000 220552.7900 134914.1500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2646 1783.000000 65971.0000 36373.6400
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 2647 1783.250000 65980.2500 36373.6400
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 4.000000 148.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 549 537.250000 25294.2500 0.0000
P 2848 2454.250000 103402.0000 103290.9700
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 3401 2995.500000 128844.2500 103290.9700
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1490 1628.250000 68585.7100 120.2500
P 2702 2877.750000 112061.7800 112061.7800
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 4192 4506.000000 180647.4900 112182.0300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 66 52.500000 2244.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 9637 8428.500000 355353.7500 0.0000
P 7 11.000000 719.7500 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 9710 8492.000000 358318.0000 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 4 4.500000 249.7500 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 4 4.500000 249.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 6.500000 253.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 543 587.000000 32650.4800 196.7900
P 1700 1845.500000 83681.5000 83563.0000
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 2253 2439.000000 116585.4800 83759.7900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 28.500000 1916.0100 0.0000
P 670 728.250000 39823.6300 39823.6300
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 689 756.750000 41739.6400 39823.6300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 54 64.250000 3745.5700 0.0000
P 650 722.750000 39873.7600 39873.8600
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 704 787.000000 43619.3300 39873.8600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1248 1412.500000 69451.9100 0.0000
P 1768 1691.000000 68972.5000 67260.1400
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 3017 3105.750000 138507.6600 67260.1400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1506 2302.750000 101700.2500 90.0000
P 2003 2973.500000 125226.9900 125072.3500
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 3511 5278.250000 227001.2400 125162.3500