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
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 13392 41943.25000 1551455.7400 36.9894
Subtotal (Total Children Is Unduplicated) 13392 41943.25000 1551455.7400 36.9894
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 21 40.000000 3000.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 42 75.500000 5662.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 25 39.500000 2962.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.000000 975.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 22.000000 1650.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 15.000000 1125.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 22 40.500000 2247.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 43 74.000000 4107.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 395 736.000000 55200.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 679 1216.402799 91191.2100 74.9679
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 136 248.000000 18600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 427 679.000000 50925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 114 204.000000 15300.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 191 330.500000 24748.5000 74.8820
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 427 793.500000 44039.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1008 1779.500000 98762.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 183 325.000000 24375.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 293 475.500000 35662.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 29 29.000000 2084.5200 71.8800
OCTH-97165-OT EVAL LOW COMPLEXITY 1 4.000000 204.2000 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
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 6.000000 315.4200 52.5700
Subtotal (Total Children Is Unduplicated) 2377 7216.402799 487235.4000 67.5178
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 5 11.000000 785.8400 71.4400
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 350 1365.750000 68250.0000 49.9725
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 345 935.750000 46787.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 32.500000 2321.8000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 12 16.000000 1143.0400 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 60 198.250000 14162.9800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 67 185.750000 13269.9800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 22 43.000000 3071.9200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 6 5.000000 357.2000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 94 418.250000 29879.7800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 46 72.000000 5143.6800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 71.000000 5072.2400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 17 21.500000 1535.9600 71.4400
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 127 514.500000 36684.4400 71.3011
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 97 263.250000 18806.5800 71.4400
Subtotal (Total Children Is Unduplicated) 982 4153.500000 247272.9400 59.5336
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Total 53313.152799 2285964.0800 42.8781
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Number of Children (Unduplicated) With at Least One Service 13600
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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 1598 1026.000000 45199.2000 0.0000
H 3184 2189.000000 90110.7600 90110.7600
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 34 21.250000 1204.2500 0.0000
---------------------------------------------------------
Total 4816 3236.250000 136514.2100 90110.7600
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 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 1618 1208.250000 50800.2500 0.0000
---------------------------------------------------------
Total 1618 1208.250000 50800.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 25.000000 925.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3720 2809.750000 123289.7700 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
19 22.500000 1635.8800 0.0000
Other 574 473.000000 19975.5300 0.0000
---------------------------------------------------------
Total 4349 3332.250000 145976.1800 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 33.750000 1390.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1187 1897.500000 78282.6000 0.0000
P 1908 3246.500000 128039.0000 127578.1700
D 112 183.500000 7568.7500 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
193 237.750000 14666.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3428 5599.000000 229947.0200 127578.1700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2419 1577.250000 58358.2500 31101.1400
P 0 0.000000 0.0000 0.0000
D 16 7.750000 286.7500 111.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2 1.000000 37.0000 0.0000
Other 10 4.000000 148.0000 0.0000
---------------------------------------------------------
Total 2448 1590.250000 58839.2500 31212.1400
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
5872 4585.500000 189379.0000 0.0000
Other 2 0.750000 27.7500 0.0000
---------------------------------------------------------
Total 5874 4586.250000 189406.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 501 466.000000 21521.0000 0.0000
P 2686 2295.000000 96175.7500 96064.7200
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
3 2.750000 101.7500 0.0000
Other 51 27.500000 1017.5000 0.0000
---------------------------------------------------------
Total 3243 2792.750000 118871.5000 96064.7200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1425 1528.500000 63475.2100 120.2500
P 2582 2692.250000 104146.2800 104146.2800
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 15 8.500000 314.5000 0.0000
---------------------------------------------------------
Total 4022 4229.250000 167935.9900 104266.5300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 26.750000 989.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 9171 7910.250000 331264.7500 0.0000
P 5 8.000000 524.0000 0.0000
D 55 50.750000 2693.7500 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
514 291.000000 10994.0000 0.0000
Other 357 279.500000 11078.5000 0.0000
---------------------------------------------------------
Total 10142 8566.250000 357544.7500 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
4 5.000000 326.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8 9.500000 576.0000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 520 557.000000 30973.4800 196.7900
P 1612 1717.250000 77700.0000 77624.1700
D 0 0.000000 0.0000 0.0000
S 246 228.750000 9194.2500 344.2100
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8 10.250000 379.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2395 2518.750000 118450.4800 78165.1700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 17.500000 1130.0100 0.0000
P 623 672.500000 36608.3800 36608.3800
D 44 38.500000 2526.5800 0.0000
S 207 126.250000 4802.7500 0.0000
H 52 49.750000 2252.5100 0.0000
T 0 0.000000 0.0000 0.0000
2860 2551.250000 124324.5300 0.0000
Other 27 15.750000 748.6900 0.0000
---------------------------------------------------------
Total 3826 3471.500000 172393.4500 36608.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 62.250000 3595.5700 0.0000
P 565 608.250000 33056.2600 33056.3600
D 17 17.750000 1149.2700 0.0000
S 100 106.500000 7656.4200 0.0000
H 5 3.750000 242.0700 0.0000
T 0 0.000000 0.0000 0.0000
4645 4079.000000 181665.0800 0.0000
Other 62 36.000000 1425.2200 196.2500
---------------------------------------------------------
Total 5447 4913.500000 228789.8900 33252.6100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1108 1153.000000 55125.4100 0.0000
P 1580 1418.750000 56473.2500 55840.0600
D 0 0.000000 0.0000 0.0000
S 3 3.402799 217.2100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 2.000000 150.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2693 2579.402799 112049.1200 55840.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1305 1943.000000 84485.5000 90.0000
P 1766 2525.250000 105396.9900 105242.7200
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 27 46.000000 1854.0000 1404.2100
3 2.000000 74.0000 0.0000
Other 134 161.750000 5984.7500 0.0000
---------------------------------------------------------
Total 3237 4680.000000 197869.2400 106736.9300