CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 9469 29895.75000 1111251.7500 37.1709
Subtotal (Total Children Is Unduplicated) 9469 29895.75000 1111251.7500 37.1709
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 33.500000 2512.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 21 37.500000 2812.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 22 39.500000 2962.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 18.000000 1350.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 29.500000 1637.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 46 86.000000 4773.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 326 619.500000 46462.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 492 854.500000 64058.2500 74.9658
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 94 168.000000 12600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 290 479.000000 35925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 104 196.000000 14700.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 171 303.000000 22725.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 316 607.500000 33716.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 835 1458.500000 80946.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 148 257.500000 19312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 154 271.000000 20325.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.000000 380.7500 76.1500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 21 21.000000 1050.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 4 10.000000 529.3000 52.9300
Subtotal (Total Children Is Unduplicated) 1875 5542.000000 372028.3300 67.1289
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 310 1263.750000 63187.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 164 433.250000 21662.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 47.000000 3382.1200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 6.250000 449.7500 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 1.250000 72.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 61 261.500000 18817.5400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 32 74.000000 5325.0400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 16 51.500000 3705.9400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 82 341.500000 24574.3400 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 19 22.750000 1637.0900 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 63.750000 4587.4500 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 7.750000 557.6900 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 96 432.750000 31078.2100 71.8156
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 41 100.750000 7249.9700 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
Subtotal (Total Children Is Unduplicated) 711 3108.750000 186301.1000 59.9280
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Total 38546.500000 1669581.1800 43.3134
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Number of Children (Unduplicated) With at Least One Service 9738
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Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 27.500000 1023.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2134 1542.500000 59636.0000 0.0000
P 43 51.750000 2316.5500 2316.5500
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 2223 1621.750000 62975.5500 2316.5500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 118.000000 4671.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 1783 2648.500000 106460.7000 0.0000
P 891 1452.000000 58283.8500 53956.7500
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 2760 4218.500000 169416.4500 53956.7500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 2937 1814.750000 67462.1000 31536.1400
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 2943 1817.750000 67573.7000 31536.1400
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.250000 455.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 1028 825.750000 36201.7000 0.0000
P 1597 1419.250000 64136.7000 71390.0000
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 2640 2257.250000 100794.1000 71390.0000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 6.000000 259.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1792 2024.750000 82251.6700 5241.5600
P 2103 2308.750000 93369.8200 93151.4800
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 3903 4339.500000 175881.2900 98393.0400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 42.250000 1796.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 8558 7520.250000 321693.0500 0.0000
P 4 13.250000 935.5200 137.5000
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 8611 7575.750000 324424.6700 137.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 10 14.500000 999.7500 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 10 14.500000 999.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 37 40.750000 2754.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1068 1071.000000 51655.2400 27.9000
P 820 847.750000 40293.4000 161156.9800
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 1925 1959.500000 94703.3600 161184.8800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 45.250000 2766.2800 0.0000
U 0 0.000000 0.0000 0.0000
B 838 787.000000 41522.6200 18.6000
P 1912 1757.250000 87316.8500 87284.2800
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2796 2589.500000 131605.7500 87302.8800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 43.000000 2752.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 1148 1093.750000 51758.8600 46.5000
P 4109 3650.500000 167956.6300 167739.1200
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 5296 4787.250000 222468.4100 167785.6200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2053 1819.250000 80171.9100 0.0000
P 903 860.500000 35522.1500 35522.0000
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 2956 2679.750000 115694.0600 35522.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 148 213.750000 7951.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2057 3058.500000 131236.5000 0.0000
P 909 1413.250000 63856.0900 63846.4960
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 3114 4685.500000 203044.0900 63846.4960