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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 943 3764.750000 140030.1000 37.1951
Subtotal (Total Children Is Unduplicated) 943 3764.750000 140030.1000 37.1951
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 13.000000 975.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 21.500000 1612.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 10 17.000000 943.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 27.500000 1526.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 158 290.500000 21787.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 192 322.000000 24120.7500 74.9092
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 43 68.000000 5100.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 106 177.500000 13312.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 38 70.000000 5250.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 84 134.000000 10050.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 201 357.500000 19841.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 288 492.500000 27333.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 61 101.500000 7612.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 66 117.500000 8812.5000 75.0000
Subtotal (Total Children Is Unduplicated) 698 2236.000000 150228.0000 67.1860
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 9.500000 475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
Subtotal (Total Children Is Unduplicated) 4 13.500000 696.9600 51.6267
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Total 6014.250000 290955.0600 48.3776
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Number of Children (Unduplicated) With at Least One Service 976
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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 288 277.500000 13561.7500 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 48 72.250000 4846.2000 0.0000
---------------------------------------------------------
Total 336 349.750000 18407.9500 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 217 200.500000 9284.2500 0.0000
---------------------------------------------------------
Total 217 200.500000 9284.2500 0.0000
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
1 1.500000 83.2500 0.0000
Other 15 23.000000 892.2000 0.0000
---------------------------------------------------------
Total 109 146.250000 5902.2000 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
48 55.500000 3271.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 233 350.750000 16081.5000 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 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 242 216.500000 8053.8000 1115.7500
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
254 294.500000 14241.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 254 294.500000 14241.9000 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 99 129.750000 6697.5000 0.0000
P 115 142.500000 6530.4000 6511.8000
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
4 3.500000 130.2000 0.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 219 277.250000 13413.9000 6511.8000
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 47 75.500000 3460.5000 3457.2500
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
12 21.500000 1612.5000 0.0000
Other 52 97.000000 6885.0000 0.0000
---------------------------------------------------------
Total 244 388.250000 20927.5500 3457.2500
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
9 7.500000 279.0000 0.0000
Other 4 3.750000 139.5000 0.0000
---------------------------------------------------------
Total 523 670.000000 31757.5500 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 142 186.000000 8941.2000 8941.2000
D 0 0.000000 0.0000 0.0000
S 21 17.000000 820.2000 82.2000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 12.500000 801.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 221 289.750000 14490.9000 9023.4000
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 23 18.250000 849.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
25 38.500000 2187.3000 0.0000
Other 26 24.750000 1220.1000 0.0000
---------------------------------------------------------
Total 415 440.250000 21524.5500 12927.3000
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 3 6.000000 450.0000 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
59 105.000000 6422.2500 0.0000
Other 11 12.500000 578.4000 559.8000
---------------------------------------------------------
Total 683 865.000000 40888.1500 28118.2000
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 107 187.750000 9615.9000 9615.9000
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
47 92.000000 6116.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 395 728.250000 39401.0600 9615.9000
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 137 262.750000 12946.9500 12468.1500
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 2 4.000000 261.0000 112.2000
2 7.000000 350.0000 350.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 422 797.250000 36579.8000 13013.6000