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: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 21 68.250000 2536.9000 37.1707
Subtotal (Total Children Is Unduplicated) 21 68.250000 2536.9000 37.1707
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 3 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 4 7.000000 350.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 17.500000 1312.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 15.500000 1162.5000 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 7 14.000000 1050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 6.500000 468.0000 72.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 6 11.500000 638.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 25.000000 1338.3600 53.5344
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 148 295.439067 21440.4300 72.5714
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 197 373.500000 27962.5000 74.8661
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 50 96.000000 7125.0000 74.2188
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 129 240.000000 17905.0000 74.6042
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 48 95.500000 6992.5000 73.2199
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 80 152.000000 11400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 122 238.500000 13236.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 305 582.000000 32249.7500 55.4119
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 76 139.000000 10425.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 105.000000 7875.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 3648.0000 304.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 386.0000 193.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 6 7.000000 304.0000 43.4286
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 411.2800 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 16.000000 781.0200 48.8138
Subtotal (Total Children Is Unduplicated) 794 2489.939067 170568.8900 68.5032
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 17.000000 1223.3200 71.9600
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 7 5.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 3 2.500000 125.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 150 577.000000 28850.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 62.250000 3112.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 56 180.250000 12970.7900 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 25 33.750000 2428.6500 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 3 2.500000 179.9000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 57 232.000000 16694.7200 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 17 25.750000 1852.9700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 123 513.000000 36915.4800 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 36 64.500000 4641.4200 71.9600
Subtotal (Total Children Is Unduplicated) 412 1717.000000 109066.7100 63.5217
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Total 4275.189067 282172.5000 66.0023
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Number of Children (Unduplicated) With at Least One Service 1166
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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 0 0.000000 0.0000 0.0000
H 150 180.000000 12223.5200 0.0000
T 0 0.000000 0.0000 0.0000
74 87.750000 5916.8800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 224 267.750000 18140.4000 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 5 6.000000 679.0000 1090.6700
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
76 85.000000 9017.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 81 91.000000 9696.2500 1090.6700
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
234 430.500000 28923.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 234 430.500000 28923.7500 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 2 1.500000 112.5000 112.5000
D 3 6.000000 450.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
37 74.000000 5550.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 50 97.500000 7312.5000 112.5000
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 30 45.250000 2196.3400 2543.5300
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 5 12.500000 479.0500 479.0500
93 160.500000 10102.8600 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 129 220.250000 12889.2500 3022.5800
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
344 703.500000 47928.0000 0.0000
Other 6 12.500000 810.7500 0.0000
---------------------------------------------------------
Total 350 716.000000 48738.7500 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 58 90.000000 5305.1900 3754.1900
D 201 211.000000 11121.4600 0.0000
S 0 0.000000 0.0000 0.0000
H 129 164.750000 10719.2800 0.0000
T 233 253.500000 15067.4400 10111.1800
197 233.250000 13898.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 818 952.500000 56112.0900 13865.3700
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 5 3.000000 111.2500 0.0000
S 7 9.000000 596.9600 0.0000
H 10 10.000000 675.6800 0.0000
T 0 0.000000 0.0000 0.0000
453 484.000000 32744.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 475 506.000000 34128.4700 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 1 0.500000 35.9800 35.9800
D 64 68.000000 3641.1700 0.0000
S 0 0.000000 0.0000 0.0000
H 23 22.500000 1619.1000 0.0000
T 0 0.000000 0.0000 0.0000
492 540.000000 36536.5600 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 581 631.250000 41842.0600 35.9800
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 38 52.500000 3676.5900 0.0000
T 0 0.000000 0.0000 0.0000
38 46.439067 3328.8900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 76 98.939067 7005.4800 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 300.0000 495.2500
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
138 259.500000 17083.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 140 263.500000 17383.5000 495.2500