CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 10269 35008.25000 1301990.6000 37.1910
Subtotal (Total Children Is Unduplicated) 10269 35008.25000 1301990.6000 37.1910
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 46.500000 3487.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 25 46.500000 3487.5000 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 14 26.500000 1987.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 22.500000 1687.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 6 12.000000 900.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 29.000000 1609.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 43 80.000000 4440.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 437 823.500000 61687.5000 74.9089
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 551 967.000000 72466.5000 74.9395
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 110 190.000000 14250.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 291 506.000000 37950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 129 236.000000 17700.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 175 300.500000 22537.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 515 946.500000 52503.0000 55.4707
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 831 1493.500000 82889.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 194 313.000000 23437.5000 74.8802
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 244.000000 18300.0000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 17 17.000000 850.0000 50.0000
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TLGT-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 1 1.000000 51.4100 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 8 30.000000 1587.9000 52.9300
Subtotal (Total Children Is Unduplicated) 2200 6365.000000 426124.1600 66.9480
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 345 1516.500000 75800.0000 49.9835
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 182 470.250000 23512.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 30.000000 2158.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 10 15.500000 1115.3800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 9.000000 518.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 87 322.000000 23171.1200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 48 118.500000 8527.2600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 15 50.000000 3598.0000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 89 415.250000 29881.3900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 21 29.750000 2140.8100 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 56.000000 4010.7400 71.6204
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 11.500000 827.5400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 100 371.750000 26713.0900 71.8577
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 41 106.500000 7663.7400 71.9600
Subtotal (Total Children Is Unduplicated) 771 3522.500000 209638.7700 59.5142
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Total 44895.750000 1937753.5300 43.1612
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Number of Children (Unduplicated) With at Least One Service 10504
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Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 63.500000 2362.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 1969 1331.000000 50937.6500 0.0000
P 175 104.750000 4182.0500 4111.3500
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 2193 1499.250000 57481.9000 4111.3500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2331 3444.500000 135460.6500 0.0000
P 623 1002.750000 40960.1500 40400.7000
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 2954 4447.250000 176420.8000 40400.7000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3378 2070.750000 77031.9000 14756.4500
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 3378 2070.750000 77031.9000 14756.4500
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.6000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.500000 18.6000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 6.000000 223.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 944 852.000000 39189.6000 0.0000
P 1804 1555.750000 67578.9000 67439.4000
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 2755 2413.750000 106991.7000 67439.4000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3507 3795.250000 150734.1500 211.0000
P 1049 1099.250000 46852.8500 46770.8100
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 4556 4894.500000 197587.0000 46981.8100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 6.750000 251.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 10158 8837.500000 370524.7500 0.0000
P 2 5.000000 359.8000 40.0000
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 10168 8849.250000 371135.6500 40.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 7 13.000000 750.7500 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 7 13.000000 750.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 20.000000 883.0400 0.0000
U 0 0.000000 0.0000 0.0000
B 875 908.250000 46050.9400 0.0000
P 1621 1697.000000 78613.7000 78614.3500
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 2515 2625.250000 125547.6800 78614.3500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 5.250000 246.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 601 564.500000 29660.8800 0.0000
P 2538 2409.500000 120831.8700 120778.4900
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 3145 2979.250000 150739.2500 120778.4900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 18.750000 842.6200 0.0000
U 0 0.000000 0.0000 0.0000
B 1083 1029.500000 50927.2200 109.1600
P 4842 4540.750000 208083.0300 207779.7200
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 5941 5589.000000 259852.8700 207888.8800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2729 2819.750000 125792.6500 0.0000
P 1059 1074.750000 45926.7000 45926.7000
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 3788 3894.500000 171719.3500 45926.7000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2569 3802.500000 160312.9500 334.3500
P 1195 1817.000000 82163.1300 81263.4800
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 3764 5619.500000 242476.0800 81597.8300