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
Agency Filter:EXT
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 94 133.250000 4956.9000 37.2000
Subtotal (Total Children Is Unduplicated) 94 133.250000 4956.9000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 10.000000 750.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 6.500000 487.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 14.000000 777.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 15 28.500000 1581.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 38 74.000000 5550.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 111 213.500000 16012.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 24.000000 1800.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 70 131.000000 9825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 64.500000 4837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 79.500000 5962.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 92 174.500000 9684.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 174 318.500000 17676.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 28 49.000000 3675.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 71 129.000000 9675.0000 75.0000
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 4 4.000000 205.6400 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 1 1.000000 51.4100 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 9 9.000000 450.0000 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-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 13.000000 668.3300 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 747 1501.250000 98508.3075 65.6175
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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 3986 26056.75000 1302757.5000 49.9969
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1059 4635.750000 231545.5000 49.9478
OCCT-97530-OT SESSION BY LICENSED OT 369 1758.500000 126469.7000 71.9191
OCCT-97530GT-OT SESSION BY LICENSED OT 48 121.250000 8725.1500 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 154 879.500000 50659.1600 57.6000
OCCT-97530HMGT-OT SESSION BY OT ASST 6 15.500000 892.8000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 26 95.500000 6872.1800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 9.000000 647.6400 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 10 57.000000 3283.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 352 1593.500000 114668.2600 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 28 105.500000 7591.7800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 5 8.000000 575.6800 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 9 45.750000 2633.3700 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 524 3045.500000 218800.4600 71.8439
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 76 264.750000 19024.7000 71.8591
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 37 163.250000 11747.4700 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 143.9200 47.9733
Subtotal (Total Children Is Unduplicated) 5595 39281.75000 2131791.5100 54.2693
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Total 40916.250000 2235256.7175 54.6300
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Number of Children (Unduplicated) With at Least One Service 6170
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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 8 15.500000 1084.5000 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 140 237.500000 15960.0000 0.0000
---------------------------------------------------------
Total 208 313.500000 20132.6700 50.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 62 46.000000 1711.2000 0.0000
P 36 32.750000 1320.7000 960.6500
D 1 1.000000 37.2000 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
85 60.500000 2289.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1578 5316.750000 266170.2800 960.6500
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
4949 4861.250000 249548.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4949 4861.250000 249548.1100 0.0000
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 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
1399 4904.500000 269642.4700 0.0000
Other 157 303.500000 21699.7500 0.0000
---------------------------------------------------------
Total 1556 5208.000000 291342.2200 0.0000
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 2 5.000000 359.8000 40.0000
D 2 4.000000 221.9600 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
3614 11254.750000 648026.2175 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3621 11270.750000 649023.8575 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 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
358 1080.500000 65719.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 358 1080.500000 65719.6300 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 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
495 1028.750000 60595.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 495 1028.750000 60595.1400 0.0000
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 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
1301 1358.000000 69989.0700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1301 1358.000000 69989.0700 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 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
1707 1820.500000 96580.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1707 1820.500000 96580.8400 0.0000
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 0 0.000000 0.0000 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 3067 3131.750000 186919.6100 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 1 1.250000 46.5000 0.0000
P 13 25.750000 1644.4800 1644.4800
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
1511 5499.500000 277544.3100 277544.3100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1525 5526.500000 279235.2900 279188.7900