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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 732 822.500000 30596.7500 37.1997
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 93 93.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1432 6010.500000 223389.3000 37.1665
Subtotal (Total Children Is Unduplicated) 1461 6926.000000 253986.0500 36.6714
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 14.000000 700.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 0.500000 25.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 14 26.500000 1987.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 28.000000 2100.0000 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 18 32.000000 2400.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.000000 900.0000 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 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 9 16.500000 915.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 59.000000 3274.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 178 340.000000 25330.0000 74.5000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 371 615.500000 46162.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 52 95.000000 6875.0000 72.3684
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 200 319.000000 23925.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 90.500000 6750.0000 74.5856
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 146 240.000000 18000.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 239 432.500000 24003.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 597 1002.000000 55615.2500 55.5042
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 63 106.500000 7987.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 208.000000 15600.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 15 15.000000 2509.3500 167.2900
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1129 3690.000000 247750.0100 67.1409
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 43 49.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 23.000000 1150.0000 50.0000
INTR-T1013-INTERPRETER 30 68.750000 3437.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 91 156.000000 1560.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 4.000000 287.8400 71.9600
TRAV-TRAVS-Travel by mile 99 3822.000000 1698.4400 0.4444
Subtotal (Total Children Is Unduplicated) 185 4123.750000 8146.2800 1.9755
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Total 14739.750000 509882.3400 34.5923
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Number of Children (Unduplicated) With at Least One Service 1514
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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 18 60.750000 1043.8900 1043.8900
D 3 31.000000 162.0500 0.0000
S 185 158.000000 7459.8000 0.0000
H 15 18.000000 1223.2500 0.0000
T 21 28.000000 1226.7500 1226.7500
120 83.750000 3228.9000 0.0000
Other 25 31.750000 2120.1000 0.0000
---------------------------------------------------------
Total 387 411.250000 16464.7400 2270.6400
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 51 1506.250000 3158.7900 3148.1100
3 118.000000 52.5100 0.0000
Other 481 795.750000 12622.3300 0.0000
---------------------------------------------------------
Total 535 2420.000000 15833.6300 3148.1100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 70 98.250000 3997.1500 0.0000
P 27 48.000000 3312.3000 3312.3000
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
227 269.500000 11415.4500 0.0000
Other 33 36.750000 1422.0000 0.0000
---------------------------------------------------------
Total 357 452.500000 20146.9000 3312.3000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 6.000000 298.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 126 196.750000 8252.1000 0.0000
P 53 91.500000 3701.4500 3965.5500
D 2 1.250000 46.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 8.000000 487.8400 0.0000
T 0 0.000000 0.0000 0.0000
325 362.000000 19749.8500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 513 665.500000 32536.5400 3965.5500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 204 186.000000 6912.5000 3352.1600
P 164 964.750000 10091.1900 10091.1900
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
452 398.500000 12059.9900 163.6400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 820 1549.250000 29063.6800 13606.9900
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
727 798.000000 37906.8500 0.0000
Other 9 6.500000 241.8000 0.0000
---------------------------------------------------------
Total 736 804.500000 38148.6500 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 48 56.500000 2891.4000 0.0000
P 107 143.400000 6680.2500 6680.2500
D 1 2.000000 150.0000 0.0000
S 3 1.250000 46.5000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
266 219.850000 8525.2000 0.0000
Other 12 10.000000 371.7000 0.0000
---------------------------------------------------------
Total 440 439.000000 19115.0500 6680.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 111.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 100.000000 4652.2000 166.8000
P 342 481.500000 21743.3500 21631.9200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 154 209.000000 11709.2500 0.0000
T 121 155.750000 6673.7500 6673.7500
60 113.250000 7456.2000 0.0000
Other 46 87.500000 6192.0000 0.0000
---------------------------------------------------------
Total 790 1149.000000 58537.7500 28472.4700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 384 486.500000 24001.2500 0.0000
P 2 18.000000 540.0000 540.0000
D 8 12.500000 672.9000 0.0000
S 4 7.250000 269.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
393 684.000000 32735.1000 0.0000
Other 5 6.500000 241.8000 0.0000
---------------------------------------------------------
Total 796 1214.750000 58460.7500 540.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.500000 112.5000 0.0000
P 15 15.000000 468.5000 468.5000
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
3 3.000000 181.9100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19 19.500000 762.9100 468.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 261.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 40 58.750000 3123.9500 0.0000
P 45 70.750000 3801.7000 3450.3900
D 12 24.000000 1527.0000 0.0000
S 21 15.750000 585.9000 0.0000
H 7 14.000000 1050.0000 0.0000
T 36 478.000000 1354.3100 1254.3100
132 145.000000 6553.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 295 810.250000 18257.3600 4704.7000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 4.250000 158.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 66 62.250000 3094.0000 0.0000
P 180 186.000000 8970.7000 8966.2000
D 14 10.500000 454.5500 0.0000
S 5 6.500000 355.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 12 150.000000 124.0700 124.0700
426 368.250000 13743.2500 0.0000
Other 5 6.000000 223.0500 0.0000
---------------------------------------------------------
Total 712 793.750000 27122.9200 9090.2700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 9.000000 542.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 94 130.500000 6358.0500 37.2000
P 387 462.250000 20450.3000 20441.7000
D 17 23.000000 1250.7000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 16 78.000000 860.1300 860.1300
414 623.750000 19757.6800 0.0000
Other 4 5.250000 251.2500 138.7500
---------------------------------------------------------
Total 939 1331.750000 49470.8100 21477.7800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 149 258.500000 13454.4000 0.0000
P 87 143.250000 7722.2000 7722.2000
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 10 20.000000 1450.0000 0.0000
T 0 0.000000 0.0000 0.0000
660 596.916667 27055.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 907 1020.000000 49782.5500 7722.2000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 276 566.750000 25866.5500 0.0000
P 91 170.000000 8570.7500 8570.1500
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 9 25.000000 769.1000 676.6600
535 860.250000 39604.6000 400.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 925 1658.750000 76178.1000 9646.8100