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
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 12224 37642.00000 1399817.1500 37.1876
Subtotal (Total Children Is Unduplicated) 12224 37642.00000 1399817.1500 37.1876
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 26 44.000000 3300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 25 43.500000 3225.0000 74.1379
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 11.000000 825.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 13 22.500000 1687.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 20.500000 1537.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 15.000000 1125.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 58.000000 3219.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 39 70.000000 3885.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 538 935.250000 70075.5000 74.9270
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 506 938.500000 70161.0000 74.7587
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 107 185.500000 13912.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 253 466.000000 34950.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 136 256.500000 19237.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 180 320.500000 24037.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 650 1151.500000 63880.5000 55.4759
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 720 1354.000000 75147.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 237 385.000000 28800.0000 74.8052
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 88 165.000000 12375.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 23 23.000000 1150.0000 50.0000
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 565.5100 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 205.6400 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 19.000000 1002.6300 52.7700
Subtotal (Total Children Is Unduplicated) 2083 6516.750000 435522.4200 66.8312
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 416 1850.750000 92512.5000 49.9865
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 205 586.000000 29268.5000 49.9462
OCCT-97530-OT SESSION BY LICENSED OT 14 21.060000 1514.9600 71.9354
OCCT-97530GT-OT SESSION BY LICENSED OT 6 8.130000 584.5400 71.8991
OCCT-97530TL-OT SESSION BY LICENSED OT 75 334.500000 23908.7100 71.4760
OCCT-97530TLGT-OT SESSION BY LICENSED OT 36 105.000000 7555.8000 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 14 24.000000 1724.3200 71.8467
PHY-97110TL-PT SESSION BY LICENSED PT 116 524.500000 37707.0400 71.8914
PHY-97110TLGT-PT SESSION BY LICENSED PT 26 38.000000 2734.4800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 15.000000 1079.4000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 10.500000 755.5800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 124 540.750000 38834.7700 71.8165
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 39 96.500000 6944.1400 71.9600
Subtotal (Total Children Is Unduplicated) 878 4155.690000 245182.3400 58.9992
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Total 48314.440000 2080521.9100 43.0621
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Number of Children (Unduplicated) With at Least One Service 12450
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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 255 63.750000 2371.5000 2371.5000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 256 64.000000 2380.8000 2371.5000
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 1452 984.750000 42005.0500 0.0000
---------------------------------------------------------
Total 1452 984.750000 42005.0500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 210 122.250000 4692.8000 0.0000
P 144 111.000000 4618.2500 4619.0900
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
1735 1288.250000 50050.9500 0.0000
Other 39 39.500000 1570.0500 0.0000
---------------------------------------------------------
Total 2132 1564.000000 61043.6500 4619.0900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 174 297.250000 11590.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 1849 3046.250000 118327.8000 0.0000
P 678 1155.500000 45681.6000 45603.5000
D 200 320.500000 12100.6500 0.0000
S 3 4.250000 158.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
354 486.250000 28944.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3258 5310.000000 216802.2000 45603.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 13.750000 511.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2774 1695.000000 63054.0000 31210.7000
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
1 0.500000 18.6000 0.0000
Other 36 26.750000 995.1000 0.0000
---------------------------------------------------------
Total 2842 1736.000000 64579.2000 31210.7000
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
4661 3756.500000 160044.3000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4661 3756.500000 160044.3000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 60 48.500000 2255.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1140 918.000000 41998.2000 0.0000
P 1818 1471.000000 62308.7000 62243.6000
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
5 4.250000 233.7000 0.0000
Other 124 76.250000 3287.7000 0.0000
---------------------------------------------------------
Total 3147 2518.000000 110083.7000 62243.6000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 186 182.500000 7056.0400 0.0000
U 0 0.000000 0.0000 0.0000
B 4120 4312.750000 174961.7800 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 1.000000 50.0000 0.0000
Other 7 11.500000 440.6000 0.0000
---------------------------------------------------------
Total 4314 4507.750000 182508.4200 0.0000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 75 65.500000 2436.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 9098 7978.250000 334180.9500 0.0000
P 2 2.250000 159.3000 0.0000
D 122 176.000000 11740.5000 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
372 233.500000 10483.8500 0.0000
Other 426 300.500000 11178.6000 0.0000
---------------------------------------------------------
Total 10095 8756.000000 370179.8000 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 1 1.000000 55.5000 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
8 12.000000 666.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 13.000000 721.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 939 969.000000 51434.5700 0.0000
P 1274 1310.250000 60245.8500 60245.9200
D 8 12.000000 761.0000 0.0000
S 140 135.750000 5701.8000 441.2000
H 4 4.000000 287.8400 0.0000
T 1 1.000000 71.9600 0.0000
22 16.500000 626.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2399 2457.250000 119581.5400 60687.1200
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 114 113.000000 7775.9100 0.0000
U 0 0.000000 0.0000 0.0000
B 1174 1043.500000 51417.9900 0.0000
P 2051 1850.000000 91564.5200 91489.0600
D 13 10.500000 520.4800 0.0000
S 99 95.750000 4774.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
39 28.250000 1135.2000 0.0000
Other 166 135.000000 6847.1800 59.2500
---------------------------------------------------------
Total 3656 3276.000000 164035.2800 91548.3100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2212 2035.500000 96245.0900 0.0000
P 2891 2517.000000 115915.8200 115906.5200
D 13 12.250000 710.5800 0.0000
S 16 14.000000 752.2400 0.0000
H 6 6.000000 431.7600 0.0000
T 0 0.000000 0.0000 0.0000
2 2.250000 83.7000 0.0000
Other 132 103.690000 4972.0400 504.7400
---------------------------------------------------------
Total 5281 4699.440000 219436.7300 116411.2600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2465 2384.500000 102376.2900 0.0000
P 1307 1218.000000 50101.4000 49389.6500
D 1 0.250000 9.3000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3773 3602.750000 152486.9900 49389.6500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 24.750000 920.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 2472 3481.500000 145339.2000 139.5000
P 980 1399.000000 61925.8500 61926.0300
D 1 1.250000 46.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 12.500000 820.5000 340.2000
0 0.000000 0.0000 0.0000
Other 134 150.000000 5580.0000 0.0000
---------------------------------------------------------
Total 3609 5069.000000 214632.7500 62405.7300