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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 1.000000 37.2000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26 40.250000 1497.3000 37.2000
Subtotal (Total Children Is Unduplicated) 28 41.750000 1534.5000 36.7545
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 17 31.000000 2325.0000 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 9 18.500000 1387.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 6.000000 450.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 3.500000 262.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 3.000000 225.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 15 30.000000 1665.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 37.000000 2053.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 172 343.458666 25379.4000 73.8936
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 212 399.229866 29640.6800 74.2446
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 46 90.000000 6750.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 129 245.000000 18330.1500 74.8169
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 55 100.500000 7537.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 75 135.500000 10162.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 133 256.000000 14208.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 333 630.000000 34815.0000 55.2619
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 135 231.500000 17362.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 42 78.049400 5791.2000 74.1992
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 24 24.000000 7296.0000 304.0000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 8.000000 344.3400 43.0425
Subtotal (Total Children Is Unduplicated) 899 2719.237932 189222.0500 69.5864
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 6 12.000000 863.5200 71.9600
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 4 4.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 174 835.250000 41697.5000 49.9222
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 36 86.750000 4337.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 65 252.250000 18151.9100 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 18 38.750000 2788.4500 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 5.000000 288.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 2 5.000000 359.8000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 58 250.250000 18007.9900 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 14 23.000000 1655.0800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 2 7.000000 503.7200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 124 569.000000 39825.1700 69.9915
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 34 64.500000 4641.4200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 3 7.000000 503.7200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 2.500000 179.9000 71.9600
Subtotal (Total Children Is Unduplicated) 437 2165.500000 133953.6800 61.8581
-----------------------------------------------------------------------------------------------------------------------
Total 4926.487932 324710.2300 65.9111
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1289
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
H 239 280.250000 18982.4700 0.0000
T 0 0.000000 0.0000 0.0000
130 166.000000 11216.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 369 446.250000 30198.4700 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 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 111.0000 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 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
6 9.000000 597.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 9.000000 597.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 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
121 137.000000 15556.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 121 137.000000 15556.5000 0.0000
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
235 429.500000 28500.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 235 429.500000 28500.4500 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 0 0.000000 0.0000 0.0000
P 1 1.049400 78.7000 78.7000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
35 65.000000 4837.2000 0.0000
Other 5 10.000000 750.0000 0.0000
---------------------------------------------------------
Total 45 84.049400 6265.9000 78.7000
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 9 13.000000 483.6000 483.6000
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
132 218.500000 13920.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 141 231.500000 14403.7100 483.6000
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 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
395 800.500000 54626.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 395 800.500000 54626.2500 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 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
1 1.500000 112.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.500000 112.5000 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 56 75.000000 3998.2000 2832.9000
D 238 250.500000 13494.0000 165.0000
S 2 2.750000 203.9700 130.0000
H 222 264.000000 15552.5500 0.0000
T 402 426.500000 23796.5000 16580.2200
92 106.750000 6579.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1012 1125.500000 63624.6500 19708.1200
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 1 1.000000 71.9600 72.0000
D 27 23.250000 1572.9000 0.0000
S 1 1.500000 150.0000 0.0000
H 42 42.000000 2821.6300 0.0000
T 0 0.000000 0.0000 0.0000
485 517.250000 34082.4500 0.0000
Other 2 2.000000 100.0000 0.0000
---------------------------------------------------------
Total 558 587.000000 38798.9400 72.0000
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 37 35.000000 2275.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 77 80.000000 5345.8900 0.0000
T 0 0.000000 0.0000 0.0000
468 493.000000 33123.7200 0.0000
Other 1 0.500000 18.6000 0.0000
---------------------------------------------------------
Total 583 608.500000 40763.4900 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 69 110.500000 8142.4700 0.0000
T 0 0.000000 0.0000 0.0000
53 57.688532 4123.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 122 168.188532 12265.5300 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 0 0.000000 0.0000 0.0000
P 2 3.000000 195.7500 430.0900
D 2 4.000000 261.0000 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
155 289.000000 18429.0900 150.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 159 296.000000 18885.8400 580.0900