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
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 12279 35573.75000 1322425.4000 37.1742
Subtotal (Total Children Is Unduplicated) 12279 35573.75000 1322425.4000 37.1742
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Screening, Eval, and Assessment,Class #02
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 19 35.000000 2625.0000 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 19 32.000000 2400.0000 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 7 12.000000 900.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 16 31.000000 1720.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 41 71.500000 3968.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 289 539.000000 40425.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 517 901.500000 67583.2500 74.9676
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 103 188.000000 14100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 312 513.500000 38473.5000 74.9241
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 109 208.000000 15600.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 170 316.000000 23700.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 334 632.500000 35103.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 884 1531.500000 84998.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 209 377.500000 28312.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 188 305.500000 22912.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 1066.1000 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 24 24.000000 1200.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 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 5 14.000000 741.0200 52.9300
Subtotal (Total Children Is Unduplicated) 1904 5821.000000 391127.4900 67.1925
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 366 1434.750000 71737.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 200 520.500000 26025.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 34.000000 2446.6400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 6 6.250000 449.7500 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 76 300.500000 21623.9800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 37 80.000000 5756.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 15 47.000000 3382.1200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 104 415.500000 29899.3800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 20 25.750000 1852.9700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 22 55.750000 4011.7700 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 104 451.500000 32427.4600 71.8216
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 46 110.750000 7969.5700 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.9200 13.9600
Subtotal (Total Children Is Unduplicated) 825 3492.000000 208168.5500 59.6130
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Total 44886.750000 1921721.4400 42.8127
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Number of Children (Unduplicated) With at Least One Service 12556
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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 3398 2262.750000 96931.7200 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 25 11.000000 560.4000 0.0000
---------------------------------------------------------
Total 3423 2273.750000 97492.1200 0.0000
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 1056 824.500000 36432.7000 0.0000
---------------------------------------------------------
Total 1056 824.500000 36432.7000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 27.500000 1023.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2064 1444.250000 55638.8500 0.0000
P 39 45.750000 2056.7500 2056.7500
D 3 4.250000 214.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 150.0000
T 0 0.000000 0.0000 0.0000
7 8.000000 386.0000 0.0000
Other 132 137.750000 5362.7000 0.0000
---------------------------------------------------------
Total 2292 1669.500000 64832.1000 2206.7500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 81 111.750000 4363.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1642 2438.250000 97706.4000 0.0000
P 832 1350.250000 53579.5000 50430.1500
D 54 69.500000 2805.0000 0.0000
S 1 0.750000 27.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
344 473.000000 23388.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2954 4443.500000 181870.9000 50430.1500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 2733 1628.750000 60549.6000 28183.9800
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
2 0.750000 27.9000 0.0000
Other 35 24.250000 901.0000 0.0000
---------------------------------------------------------
Total 2776 1656.750000 61590.1000 28183.9800
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
5019 3880.750000 159701.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5019 3880.750000 159701.7000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.250000 455.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 980 769.250000 33310.3000 0.0000
P 1514 1307.250000 58554.4500 65807.7500
D 0 0.000000 0.0000 0.0000
S 13 13.250000 492.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
24 16.750000 774.3000 0.0000
Other 133 70.250000 2613.2500 0.0000
---------------------------------------------------------
Total 2679 2189.000000 96200.9000 65807.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1726 1924.750000 77599.4700 5074.7600
P 2023 2175.250000 87384.4700 87278.9300
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 6 3.000000 111.6000 111.0000
1 1.000000 71.9600 0.0000
Other 4 3.500000 130.2000 0.0000
---------------------------------------------------------
Total 3767 4111.500000 165446.5000 92464.6900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 42.250000 1796.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 8174 7033.750000 297691.8000 0.0000
P 0 0.000000 0.0000 0.0000
D 105 132.000000 7839.9000 0.0000
S 375 219.000000 8259.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
319 155.250000 5775.2500 0.0000
Other 625 584.750000 24648.3000 0.0000
---------------------------------------------------------
Total 9647 8167.000000 346010.3500 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 9 13.000000 887.2500 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 9 13.000000 887.2500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 36.750000 2493.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1028 1012.250000 48531.2900 27.9000
P 782 791.000000 37394.7000 158259.0800
D 0 0.000000 0.0000 0.0000
S 96 73.500000 2771.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
45 47.000000 1847.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1986 1960.500000 93038.4600 158286.9800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 41.000000 2608.1800 0.0000
U 0 0.000000 0.0000 0.0000
B 772 724.750000 38428.6200 18.6000
P 1732 1571.250000 78346.1500 78318.0800
D 94 82.750000 4030.5100 0.0000
S 28 29.500000 1757.1800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
139 116.000000 4961.9800 0.0000
Other 121 94.000000 3798.9400 0.0000
---------------------------------------------------------
Total 2928 2659.250000 133931.5600 78336.6800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 32 34.000000 2210.2200 0.0000
U 0 0.000000 0.0000 0.0000
B 1054 963.250000 45400.8100 9.3000
P 3722 3188.250000 147506.3300 147297.4200
D 60 58.750000 3326.4800 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 74.250000 3008.1400 0.0000
Other 111 85.500000 3806.5100 1147.2000
---------------------------------------------------------
Total 5063 4404.000000 205258.4900 148453.9200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1904 1560.750000 66717.5100 0.0000
P 835 755.250000 30443.9500 30443.8000
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
1 2.000000 74.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2740 2318.000000 97235.8600 30443.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 134 177.000000 6584.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1781 2491.750000 105369.9500 0.0000
P 814 1229.250000 54298.4500 54289.4560
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 81 121.250000 4510.5000 4486.3000
6 11.500000 427.8000 0.0000
Other 259 285.000000 10601.3500 0.0000
---------------------------------------------------------
Total 3075 4315.750000 181792.4500 58775.7560