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:EIP DEI DEIP
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 13012 40108.00000 1491663.0000 37.1912
Subtotal (Total Children Is Unduplicated) 13012 40108.00000 1491663.0000 37.1912
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 29 52.000000 3900.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 25 43.000000 3225.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 7 12.000000 900.0000 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 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 13 24.500000 1837.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.500000 1237.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 21 34.500000 1914.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 46 82.000000 4551.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 441 782.273600 58576.0200 74.8792
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 561 993.500000 74483.2500 74.9706
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 144 234.500000 17587.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 320 570.000000 42750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 117 215.000000 16125.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 186 335.000000 25125.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 613 1050.000000 58247.2500 55.4736
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 882 1584.000000 87912.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 293 474.500000 35550.0000 74.9210
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 187 350.000000 26250.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 5 5.000000 380.7500 76.1500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
SCREEN-T1023-SCREENING 21 21.000000 1050.0000 50.0000
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 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 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) 2335 6976.773600 467924.1800 67.0689
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 409 1752.000000 87575.0000 49.9857
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 221 587.750000 29387.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 18 24.000000 1727.0400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 11 16.500000 1187.3400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 100 365.250000 26283.3900 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 51 126.500000 9102.9400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 16 52.000000 3741.9200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 111 485.250000 34918.5900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 35.750000 2572.5700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 50.000000 3578.9800 71.5796
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 12.500000 899.5000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 106 391.250000 28116.3100 71.8628
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 48 123.000000 8851.0800 71.9600
Subtotal (Total Children Is Unduplicated) 883 4025.750000 238172.5600 59.1623
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Total 51110.523600 2197759.7400 43.0001
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Number of Children (Unduplicated) With at Least One Service 13260
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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 3697 2650.250000 119996.7700 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 46 21.250000 847.2000 0.0000
---------------------------------------------------------
Total 3743 2671.500000 120843.9700 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 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 2139 3196.500000 124888.6500 0.0000
P 535 882.250000 35895.3000 35697.0500
D 110 126.500000 4872.3000 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
469 631.750000 32917.4000 0.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 3254 4838.500000 198629.4500 35697.0500
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
5541 4422.000000 187288.6000 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 5543 4423.500000 187344.4000 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
5 5.000000 271.9600 0.0000
Other 1 1.250000 46.5000 0.0000
---------------------------------------------------------
Total 4382 4631.000000 185475.4100 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 0 0.000000 0.0000 0.0000
D 163 186.500000 10905.6000 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
309 156.500000 5821.8000 0.0000
Other 390 293.500000 10918.2000 0.0000
---------------------------------------------------------
Total 10527 8843.750000 368695.6500 0.0000
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
2 3.000000 166.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 16.000000 917.2500 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
16 18.500000 776.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2474 2499.500000 118910.9300 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
2 3.000000 146.3600 0.0000
Other 194 156.500000 6660.1400 0.0000
---------------------------------------------------------
Total 3180 2925.250000 147349.8900 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
0 0.000000 0.0000 0.0000
Other 94 75.500000 3532.4000 329.9200
---------------------------------------------------------
Total 5479 4984.750000 233756.8700 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3443 3262.023600 138699.3700 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 2288 3279.250000 137300.4000 251.1000
P 1045 1528.500000 67571.7000 67150.8500
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
0 0.000000 0.0000 0.0000
Other 191 219.250000 8156.1000 0.0000
---------------------------------------------------------
Total 3531 5040.500000 213972.4500 67890.8000