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
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 894 1082.500000 40222.5000 37.1570
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 127 120.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1728 7281.750000 270853.2000 37.1962
Subtotal (Total Children Is Unduplicated) 1749 8484.750000 311075.7000 36.6629
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 2 6.000000 300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 1.500000 75.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 29.000000 2175.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 37.000000 2775.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 22.500000 1687.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 33.000000 1831.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 28 48.500000 2691.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 284 526.499999 39185.0000 74.4255
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 405 673.500000 50419.0000 74.8612
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 79 134.000000 9900.0000 73.8806
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 222 368.000000 27600.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 61 115.000000 8465.0000 73.6087
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 180 292.500000 21937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 382 690.000000 38295.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 625 1052.000000 58386.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 224.000000 16800.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 137 259.000000 19425.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 14 14.000000 1977.5000 141.2500
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1395 4565.999999 306900.7500 67.2144
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1 0.750000 37.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 1 0.250000 12.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 1 0.250000 12.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 58 53.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 10.500000 525.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 5.000000 250.0000 50.0000
INTR-T1013-INTERPRETER 34 88.000000 3882.0000 44.1136
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 80 121.000000 1210.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 104 3235.000000 1439.3300 0.4449
Subtotal (Total Children Is Unduplicated) 195 3516.500000 7490.7900 2.1302
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Total 16567.249999 625467.2400 37.7532
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Number of Children (Unduplicated) With at Least One Service 1790
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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 32 66.000000 2247.7300 2247.7300
D 0 0.000000 0.0000 0.0000
S 288 277.500000 13561.7500 0.0000
H 18 27.000000 1908.0000 0.0000
T 8 10.500000 605.2500 605.2500
230 214.000000 10522.8500 0.0000
Other 59 88.750000 5937.4500 0.0000
---------------------------------------------------------
Total 635 683.750000 34783.0300 2852.9800
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 63 952.500000 4588.2400 4588.2400
4 46.000000 20.4600 0.0000
Other 632 1332.750000 18028.6900 0.0000
---------------------------------------------------------
Total 699 2331.250000 22637.3900 4588.2400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 85 112.250000 4555.0500 0.0000
P 8 9.500000 371.7000 371.7000
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
247 378.000000 13330.6700 0.0000
Other 15 23.000000 892.2000 0.0000
---------------------------------------------------------
Total 355 522.750000 19149.6200 371.7000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 130 202.000000 8860.8000 0.0000
P 52 87.750000 3744.1500 3743.0000
D 3 5.500000 204.6000 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
353 437.750000 22203.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 538 733.000000 35012.9000 3743.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 242 216.500000 8053.8000 1115.7500
P 136 838.500000 9306.9200 9306.9200
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
440 326.500000 11318.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 818 1381.500000 28678.8200 10422.6700
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 2 3.000000 225.0000 225.0000
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
629 644.500000 31198.3500 0.0000
Other 8 8.000000 297.6000 0.0000
---------------------------------------------------------
Total 639 655.500000 31720.9500 225.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 99 129.750000 6697.5000 0.0000
P 148 185.500000 8065.4000 8046.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
493 357.500000 14058.9000 0.0000
Other 13 10.250000 381.3000 0.0000
---------------------------------------------------------
Total 754 685.000000 29353.1000 8046.8000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 133 194.250000 8969.5500 0.0000
P 313 423.250000 19086.9000 19083.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 150 169.500000 9475.0500 0.0000
T 0 0.000000 0.0000 0.0000
221 309.750000 15322.1500 0.0000
Other 74 141.000000 10185.0000 0.0000
---------------------------------------------------------
Total 891 1237.750000 63038.6500 19083.6500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.750000 65.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 491 627.000000 29269.6500 0.0000
P 0 0.000000 0.0000 0.0000
D 18 30.000000 2004.3000 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
573 766.500000 38315.4000 0.0000
Other 4 3.750000 139.5000 0.0000
---------------------------------------------------------
Total 1087 1429.000000 69793.9500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.000000 37.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 49 73.250000 3890.7000 0.0000
P 151 204.000000 10055.2000 9767.8300
D 13 26.000000 1599.0000 0.0000
S 21 17.000000 820.2000 82.2000
H 18 35.000000 2283.7500 0.0000
T 54 425.500000 3104.6500 2904.6500
176 186.250000 7941.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 484 968.000000 29732.2000 12754.6800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 82 76.500000 3742.9500 0.0000
P 253 272.750000 12929.7000 12927.3000
D 6 9.500000 595.5000 0.0000
S 29 22.750000 1073.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 6 138.000000 90.0700 90.0700
598 488.250000 20147.1000 0.0000
Other 27 26.250000 1332.6000 0.0000
---------------------------------------------------------
Total 1001 1034.000000 39911.0200 13017.3700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 37.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 97 116.250000 5720.7000 0.0000
P 512 624.250000 27679.6000 27558.4000
D 4 6.750000 477.9000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 20 77.500000 1208.0200 1208.0200
653 802.250000 32858.8300 0.0000
Other 13 15.000000 747.0000 559.8000
---------------------------------------------------------
Total 1301 1645.000000 68879.2500 29326.2200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 241 448.500000 23668.2000 0.0000
P 123 218.750000 11563.9000 11563.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 21 42.000000 3100.0000 0.0000
T 0 0.000000 0.0000 0.0000
946 894.749999 38886.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1331 1603.999999 77218.5600 11563.9000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 280 522.000000 22966.0500 83.2500
P 139 265.750000 13142.7000 12809.2700
D 1 1.500000 112.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 4 11.000000 331.0000 182.2000
569 855.000000 38949.7500 350.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 994 1656.750000 75557.8000 13424.7200