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: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 4 4.000000 148.8000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19 26.500000 985.8000 37.2000
Subtotal (Total Children Is Unduplicated) 22 30.500000 1134.6000 37.2000
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 1 1.000000 50.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 12.000000 900.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 23.500000 1733.2500 73.7553
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 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 12.000000 900.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 33.000000 1831.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 228 461.436033 33613.7025 72.8459
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 202 388.964300 29172.3225 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 57 111.329866 8349.7400 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 125 245.500000 18412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 71 140.000300 10500.0225 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 81 148.000000 11100.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 296.500000 16455.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 294 570.000000 31584.3000 55.4111
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 132 222.665900 16699.9425 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 20 41.500000 3112.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 5776.0000 304.0000
SCREEN-T1023-SCREENING 7 7.000000 350.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 19.000000 865.1600 45.5347
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 11 38.000000 1884.8200 49.6005
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 7.000000 368.9900 52.7129
Subtotal (Total Children Is Unduplicated) 884 2841.396399 196793.5000 69.2594
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 14.000000 1007.4400 71.9600
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 5 4.750000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 4.000000 162.5000 40.6250
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 164 816.000000 38247.5000 46.8719
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 32 52.750000 2637.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 152.940000 11006.0800 71.9634
OCCT-97530GT-OT SESSION BY LICENSED OT 22 64.370000 4896.6800 76.0708
OCCT-97530HM-OT SESSION BY OT ASST 2 7.000000 354.1200 50.5886
OCCT-97530TL-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 52 285.250000 20529.3100 71.9695
PHY-97110GT-PT SESSION BY LICENSED PT 10 13.000000 935.4800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 112 579.000000 39864.2200 68.8501
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 27 45.750000 3273.1400 71.5440
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 1 3.000000 215.8800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 3.000000 215.8800 71.9600
Subtotal (Total Children Is Unduplicated) 392 2052.810000 123921.4100 60.3667
-----------------------------------------------------------------------------------------------------------------------
Total 4924.706399 321849.5100 65.3541
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1229
-----------------------------------------------------------------------------------------------------------------------
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
4 8.000000 600.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 8.000000 600.0000 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
101 128.500000 13871.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 101 128.500000 13871.5000 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
251 428.750000 28138.6500 0.0000
Other 4 5.250000 307.5000 0.0000
---------------------------------------------------------
Total 255 434.000000 28446.1500 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 4 4.082800 306.2100 306.2000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 37 74.000000 5550.0000 0.0000
T 0 0.000000 0.0000 0.0000
45 87.750000 6477.9000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 87 167.832800 12484.1100 306.2000
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
99 176.000000 11448.1500 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 100 178.000000 11598.1500 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 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
426 876.000000 59840.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 426 876.000000 59840.2500 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 69 97.000000 4750.1100 3240.9900
D 182 197.000000 10487.4600 172.8000
S 1 2.000000 150.0000 130.0000
H 253 314.750000 20597.9700 0.0000
T 551 573.000000 27711.4000 20545.0000
130 146.750000 8558.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1186 1330.500000 72255.4700 24088.7900
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 4 4.000000 640.0000 448.0000
D 52 55.500000 2917.2600 0.0000
S 4 4.000000 200.0000 0.0000
H 43 43.500000 3136.3400 0.0000
T 0 0.000000 0.0000 0.0000
506 536.750000 36656.0200 0.0000
Other 1 1.000000 71.9600 0.0000
---------------------------------------------------------
Total 610 644.750000 43621.5800 448.0000
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 9 6.310000 721.9200 641.9200
D 50 55.000000 3694.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 79 79.750000 5711.0200 0.0000
T 0 0.000000 0.0000 0.0000
470 516.000000 35196.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 608 657.060000 45323.3300 641.9200
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 56 97.000000 7147.2000 0.0000
T 0 0.000000 0.0000 0.0000
60 74.063599 5234.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 116 171.063599 12382.0700 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 5 10.000000 633.0000 1840.0000
D 13 23.000000 1500.7500 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
159 296.000000 19293.1500 89.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 177 329.000000 21426.9000 1929.7000