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: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 13092 40241.25000 1496619.9000 37.1912
Subtotal (Total Children Is Unduplicated) 13092 40241.25000 1496619.9000 37.1912
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 56.000000 4200.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 30 53.000000 3975.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 15 27.000000 2025.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 16 31.000000 2325.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 11 22.500000 1687.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 13 20.500000 1537.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 29 48.500000 2691.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 61 110.500000 6132.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 478 856.273600 64126.0200 74.8896
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 668 1207.000000 90495.7500 74.9758
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 156 258.500000 19387.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 388 701.000000 52575.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 149 279.500000 20962.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 229 414.500000 31087.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 705 1224.500000 67932.0000 55.4773
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1052 1902.500000 105588.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 318 523.500000 39225.0000 74.9284
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 240 479.000000 35925.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.000000 380.7500 76.1500
MED-99205-OUTPATIENT VISIT, NEW, 60 MINS 1 1.000000 142.2300 142.2300
OCTF-97168-OT RE-EVAL EST PLAN CARE 10 10.000000 514.1000 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 16 17.000000 873.9700 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 15 15.000000 771.1500 51.4100
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 5 5.000000 257.0500 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 19 24.000000 1233.8400 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 6 9.000000 462.6900 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 7 5.500000 282.7550 51.4100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 308.4600 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 30 30.000000 1500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 32 31.250000 1606.5625 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 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 14 14.000000 719.7400 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 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 9 31.000000 1640.8300 52.9300
Subtotal (Total Children Is Unduplicated) 2570 8478.023600 566432.4875 66.8119
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 13.000000 325.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4381 27808.75000 1390332.5000 49.9962
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1279 5223.500000 260933.0000 49.9537
OCCT-97530-OT SESSION BY LICENSED OT 387 1782.500000 128196.7400 71.9196
OCCT-97530GT-OT SESSION BY LICENSED OT 59 137.750000 9912.4900 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 155 883.500000 50889.5600 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 6 15.500000 892.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 126 460.750000 33155.5700 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 57 135.500000 9750.5800 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 10 57.000000 3283.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 368 1645.500000 118410.1800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 22 58.250000 4137.6000 71.0318
PHY-97110HM-PT SESSION BY PT ASST 64 324.250000 18663.8300 57.5600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 5 14.750000 849.0100 57.5600
PHY-97110TL-PT SESSION BY LICENSED PT 139 590.750000 42510.3700 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 32 43.750000 3148.2500 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 9 45.750000 2633.3700 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 542 3095.500000 222379.4400 71.8396
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 84 277.250000 19924.2000 71.8637
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 3.750000 216.0000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 9.750000 561.6000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 143 554.500000 39863.7800 71.8914
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 49 126.000000 8995.0000 71.3889
Subtotal (Total Children Is Unduplicated) 6423 43307.50000 2369964.0700 54.7241
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Total 92026.773600 4433016.4575 48.1709
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Number of Children (Unduplicated) With at Least One Service 14403
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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 59 59.500000 3038.1700 0.0000
S 3705 2665.750000 121081.2700 0.0000
H 0 0.000000 0.0000 0.0000
T 1 1.000000 50.0000 50.0000
0 0.000000 0.0000 0.0000
Other 186 258.750000 16807.2000 0.0000
---------------------------------------------------------
Total 3951 2985.000000 140976.6400 50.0000
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 1611 1234.750000 53610.4000 0.0000
---------------------------------------------------------
Total 1611 1234.750000 53610.4000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 63.500000 2362.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 1884 1218.750000 46382.6000 0.0000
P 167 95.250000 3810.3500 3739.6500
D 18 13.500000 710.1000 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
7 9.500000 380.8500 0.0000
Other 169 145.750000 5581.5000 0.0000
---------------------------------------------------------
Total 2294 1546.250000 59227.6000 3739.6500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2201 3242.500000 126599.8500 0.0000
P 571 915.000000 37216.0000 36657.7000
D 111 127.500000 4909.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 1394 5176.500000 260812.1800 0.0000
T 0 0.000000 0.0000 0.0000
554 692.250000 35206.4000 0.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 4832 10155.250000 464799.7300 36657.7000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3136 1854.250000 68978.1000 13640.7000
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
10 6.750000 251.1000 0.0000
Other 89 65.250000 2427.3000 0.0000
---------------------------------------------------------
Total 3235 1926.250000 71656.5000 13640.7000
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
10490 9283.250000 436836.7100 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 10492 9284.750000 436892.5100 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 845 722.250000 32492.1000 0.0000
P 1689 1413.250000 61048.5000 60927.6000
D 0 0.000000 0.0000 0.0000
S 1 0.500000 18.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
26 15.000000 558.0000 0.0000
Other 183 110.000000 4329.2000 0.0000
---------------------------------------------------------
Total 2751 2267.000000 98669.6000 60927.6000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3374 3601.000000 141764.6000 211.0000
P 1002 1023.750000 43392.3500 43313.5600
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
1404 4909.500000 269914.4300 0.0000
Other 158 304.750000 21746.2500 0.0000
---------------------------------------------------------
Total 5938 9839.000000 476817.6300 43524.5600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 5.000000 186.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9658 8202.250000 340864.0500 0.0000
P 2 5.000000 359.8000 40.0000
D 165 190.500000 11127.5600 0.0000
S 3 7.000000 415.8800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3923 11411.250000 653848.0175 0.0000
Other 390 293.500000 10918.2000 0.0000
---------------------------------------------------------
Total 14148 20114.500000 1017719.5075 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
360 1083.500000 65886.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 367 1096.500000 66636.8800 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 19.000000 845.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 826 835.000000 42160.2400 0.0000
P 1477 1510.000000 69635.3000 69635.9500
D 1 1.000000 50.0000 0.0000
S 137 116.000000 5442.9500 570.1000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
511 1047.250000 61371.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2969 3528.250000 179506.0700 70206.0500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 5.250000 246.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 519 488.000000 25917.9300 0.0000
P 2285 2136.750000 107902.1700 107851.1900
D 37 33.500000 1863.8900 0.0000
S 137 102.250000 4612.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1303 1361.000000 70135.4300 0.0000
Other 194 156.500000 6660.1400 0.0000
---------------------------------------------------------
Total 4481 4283.250000 217338.9600 107851.1900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 17.750000 805.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 986 913.250000 45206.5200 109.1600
P 4330 3916.500000 180403.4300 180221.3200
D 49 56.750000 3449.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 5 5.000000 359.8000 0.0000
T 0 0.000000 0.0000 0.0000
1707 1820.500000 96580.8400 0.0000
Other 94 75.500000 3532.4000 329.9200
---------------------------------------------------------
Total 7186 6805.250000 330337.7100 180660.4000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2488 2371.250000 102124.4500 0.0000
P 952 887.000000 36310.8000 36310.8000
D 0 0.000000 0.0000 0.0000
S 2 3.273600 245.5200 0.0000
H 1 0.500000 18.6000 0.0000
T 0 0.000000 0.0000 0.0000
3067 3131.750000 186919.6100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6510 6393.773600 325618.9800 36310.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2289 3280.500000 137346.9000 251.1000
P 1058 1554.250000 69216.1800 68795.3300
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 7 13.500000 944.2500 488.8500
1511 5499.500000 277544.3100 277544.3100
Other 191 219.250000 8156.1000 0.0000
---------------------------------------------------------
Total 5056 10567.000000 493207.7400 347079.5900