CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 915 3761.500000 139713.8000 37.1431
Subtotal (Total Children Is Unduplicated) 915 3761.500000 139713.8000 37.1431
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 15 27.500000 2062.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 5.500000 412.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 6 9.000000 675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 8.500000 637.5000 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 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.000000 675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 14 26.500000 1470.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 34.000000 1887.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 182 332.000000 24900.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 152 254.000000 19011.0000 74.8465
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 21 37.500000 2812.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 99 170.000000 12750.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 50 91.500000 6862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 89 141.500000 10612.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 216 384.500000 21312.0000 55.4278
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 258 429.500000 23837.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 63.500000 4637.5000 73.0315
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 74.500000 5587.5000 75.0000
Subtotal (Total Children Is Unduplicated) 652 2128.000000 142355.5000 66.8964
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 21.000000 1050.0000 50.0000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 5 24.000000 1265.8800 52.7450
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Total 5913.500000 283335.1800 47.9133
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Number of Children (Unduplicated) With at Least One Service 939
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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 0 0.000000 0.0000 0.0000
H 1 0.250000 9.3000 9.3000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.250000 9.3000 9.3000
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 290 242.000000 10932.9000 0.0000
---------------------------------------------------------
Total 290 242.000000 10932.9000 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 7 11.500000 464.4000 0.0000
P 14 17.250000 714.9000 714.9000
D 1 0.500000 18.6000 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
94 122.500000 4954.6500 0.0000
Other 4 7.750000 288.3000 0.0000
---------------------------------------------------------
Total 120 159.500000 6440.8500 714.9000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.000000 596.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 113 175.500000 7238.4000 0.0000
P 55 84.500000 3648.9000 3647.6000
D 9 13.250000 492.9000 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
44 58.000000 3653.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 228 341.250000 15630.0000 3647.6000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.500000 316.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 244 221.250000 8230.5000 3766.5400
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 251 229.750000 8546.7000 3766.5400
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
361 424.000000 20684.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 361 424.000000 20684.3000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.500000 93.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 52 65.000000 3015.6000 0.0000
P 89 92.750000 4150.8000 4160.1000
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 150.0000 0.0000
---------------------------------------------------------
Total 146 162.250000 7409.4000 4160.1000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 13.250000 492.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 151 239.250000 11199.1500 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
17 33.000000 2475.0000 0.0000
Other 34 63.000000 4520.2500 0.0000
---------------------------------------------------------
Total 212 348.500000 18687.3000 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 2.250000 83.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 558 714.000000 33119.8500 0.0000
P 0 0.000000 0.0000 0.0000
D 13 21.250000 1470.9000 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 8.000000 297.6000 0.0000
Other 5 5.750000 213.9000 0.0000
---------------------------------------------------------
Total 590 751.250000 35185.9500 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
3 4.500000 249.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 4.500000 249.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.250000 233.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 59 96.750000 5291.7000 74.4000
P 87 125.250000 6190.5000 6190.5000
D 0 0.000000 0.0000 0.0000
S 22 26.000000 1153.8000 122.7000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
14 20.250000 1165.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 184 272.500000 14035.2000 6387.6000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.500000 112.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 139 152.500000 7360.5000 0.0000
P 269 283.500000 13049.1500 13049.1500
D 2 3.000000 205.5000 0.0000
S 2 2.250000 159.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
39 57.000000 3328.0000 0.0000
Other 8 4.500000 167.4000 0.0000
---------------------------------------------------------
Total 460 504.250000 24382.3500 13049.1500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 218 282.750000 13833.2600 0.0000
P 355 451.000000 19864.8200 19864.8200
D 0 0.000000 0.0000 0.0000
S 1 3.000000 111.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
65 116.000000 7383.7500 0.0000
Other 4 4.750000 327.9000 37.5000
---------------------------------------------------------
Total 643 857.500000 41521.3300 19902.3200
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 271 482.500000 24360.3000 0.0000
P 132 232.250000 11537.1000 11448.3000
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
60 117.000000 7878.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 463 831.750000 43775.4000 11448.3000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 318 573.250000 25652.4000 0.0000
P 108 190.250000 9093.3000 9093.3000
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 8 12.000000 773.2500 182.7000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 438 784.250000 35844.4500 9276.0000