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: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 62 147.250000 5445.0000 36.9779
Subtotal (Total Children Is Unduplicated) 62 147.250000 5445.0000 36.9779
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 29.000000 2062.5000 71.1207
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 9 17.000000 1275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 11.500000 862.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 21.000000 978.5000 46.5952
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 23.000000 1276.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 207 407.061034 29937.0775 73.5444
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 272 519.720134 38849.0100 74.7499
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 73 144.663200 10319.7400 71.3363
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 128 247.500000 18462.7100 74.5968
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 72 135.000000 10010.0000 74.1481
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 76 136.000000 10200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 140 288.500000 15615.7500 54.1274
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 323 619.500000 34004.0000 54.8894
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 93 169.545900 12715.9425 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 89 136.500000 10237.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 3095.4000 221.1000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 193.0000 193.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 62.1000 31.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 10 10.000000 500.0000 50.0000
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 1 1.000000 51.0500 51.0500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 27.000000 1223.9700 45.3322
Subtotal (Total Children Is Unduplicated) 972 3018.490268 205749.0500 68.1629
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2 0.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 96 438.500000 21341.0000 48.6682
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 92.500000 4625.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 44 162.250000 11591.1400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 35 90.250000 6181.4540 68.4926
OCCT-97530TL-OT SESSION BY LICENSED OT 2 3.000000 214.3200 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 56 223.000000 15931.1200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 25 57.500000 4107.8000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 1.000000 71.4400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 184 718.500000 50353.7000 70.0817
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 65 165.250000 11556.5800 69.9339
Subtotal (Total Children Is Unduplicated) 428 1954.500000 126094.9940 64.5152
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Total 5120.240268 337289.0440 65.8737
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Number of Children (Unduplicated) With at Least One Service 1368
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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 1 1.000000 50.0000 0.0000
S 3 1.500000 55.5000 0.0000
H 141 179.500000 11892.0500 0.0000
T 0 0.000000 0.0000 0.0000
240 227.750000 11778.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 385 409.750000 23776.1700 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
416 520.500000 37884.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 416 520.500000 37884.0500 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 1 1.000000 75.0000 143.5100
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
84 96.500000 9235.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 85 97.500000 9310.1500 143.5100
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
195 366.250000 24700.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 195 366.250000 24700.0000 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 5 4.676400 350.7300 350.7200
D 7 14.000000 1050.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 12 24.000000 1800.0000 0.0000
T 0 0.000000 0.0000 0.0000
24 47.500000 3505.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 48 90.176400 6706.2300 350.7200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 83 121.750000 6461.8540 6508.7100
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 1 1.000000 51.0500 63.1400
123 204.250000 12825.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 207 327.000000 19338.8940 6571.8500
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
318 671.500000 46014.0000 0.0000
Other 2 4.000000 225.0000 0.0000
---------------------------------------------------------
Total 320 675.500000 46239.0000 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 86 116.250000 5927.6600 4889.3300
D 197 239.000000 12844.8800 260.0000
S 4 4.000000 200.0000 0.0000
H 145 182.500000 11603.7300 40.0000
T 298 335.500000 19523.5700 13333.3200
66 79.500000 5553.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 796 956.750000 55653.8200 18522.6500
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
566 591.000000 39224.4600 0.0000
Other 17 17.000000 1193.0400 0.0000
---------------------------------------------------------
Total 583 608.000000 40417.5000 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 1 1.000000 71.4400 0.0000
S 15 17.000000 1232.2800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
456 486.500000 33779.6200 0.0000
Other 23 23.000000 1600.2400 0.0000
---------------------------------------------------------
Total 495 527.500000 36683.5800 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 43 51.000000 3530.0100 0.0000
T 0 0.000000 0.0000 0.0000
53 81.813868 5923.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 96 132.813868 9453.4000 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 4.000000 261.0000 309.0300
D 7 13.000000 819.0000 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
209 391.500000 26046.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 218 408.500000 27126.2500 420.0300