CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 8769 27454.75000 1021187.5000 37.1953
Subtotal (Total Children Is Unduplicated) 8769 27454.75000 1021187.5000 37.1953
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 49.000000 3675.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 23 40.000000 3000.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 12.000000 900.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 12 21.500000 1612.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 9 16.000000 1200.0000 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 21 41.000000 2275.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 36 64.000000 3552.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 497 926.000000 69450.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 447 788.000000 59100.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 138 246.000000 18450.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 180 318.000000 23850.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 140 251.500000 18975.0000 75.4473
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 136 234.000000 17512.5000 74.8397
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 476 844.000000 46797.7500 55.4476
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 630 1121.000000 62254.5000 55.5348
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 142 226.000000 17100.0000 75.6637
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 195.000000 14625.0000 75.0000
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 9 9.000000 450.0000 50.0000
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 14.000000 719.7400 51.4100
Subtotal (Total Children Is Unduplicated) 1802 5453.000000 368236.8500 67.5292
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 169.6400 42.4100
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 3.000000 127.2300 42.4100
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 404 1479.250000 73962.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 165 438.000000 21900.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 14 26.000000 1870.9600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 11 16.000000 1151.3600 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 83 233.500000 16802.6600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 40 90.000000 6476.4000 71.9600
PHY-97110-PT SESSION BY LICENSED PT 14 25.750000 1852.9700 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 106 533.000000 38354.6800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 25 31.750000 2284.7300 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 39.500000 2842.4200 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 7 10.000000 719.6000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 89 273.250000 19663.0700 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 39 70.750000 5091.1700 71.9600
Subtotal (Total Children Is Unduplicated) 815 3277.750000 193369.3900 58.9946
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Total 36185.500000 1582793.7400 43.7411
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Number of Children (Unduplicated) With at Least One Service 9074
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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 3 3.000000 150.0000 150.0000
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 3 3.000000 150.0000 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2072 3383.000000 135534.1000 0.0000
P 298 521.500000 20638.8600 19823.5000
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 2372 3908.500000 156321.7600 19823.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 84 68.750000 2557.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2701 1722.250000 64067.7000 46211.7000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2785 1791.000000 66625.2000 46211.7000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.500000 18.6000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 19.500000 725.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 855 780.500000 38084.2000 0.0000
P 1792 1486.000000 64411.7500 64411.7500
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 2678 2286.000000 103221.3500 64411.7500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 103 98.500000 3819.6800 0.0000
U 0 0.000000 0.0000 0.0000
B 3199 3471.250000 144134.3300 0.0000
P 148 155.500000 8153.1000 8189.7000
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 3450 3725.250000 156107.1100 8189.7000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 322 274.750000 10586.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 7849 7072.000000 309288.3000 0.0000
P 14 24.250000 1508.5500 133.0000
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 8185 7371.000000 321383.1000 133.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 29 29.500000 1637.2500 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 29.500000 1637.2500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 34 34.000000 1986.1200 0.0000
U 0 0.000000 0.0000 0.0000
B 862 853.500000 40705.0600 50.0000
P 1350 1343.250000 65233.3800 65183.5800
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 2246 2230.750000 107924.5600 65233.5800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 80 64.750000 3757.9500 0.0000
U 0 0.000000 0.0000 0.0000
B 736 671.250000 34949.1800 0.0000
P 2229 2055.500000 100648.0900 100632.5300
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 3045 2791.500000 139355.2200 100632.5300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 72 76.750000 4589.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 1007 1018.000000 47980.9000 109.1600
P 3386 3170.000000 146215.4900 146014.0400
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 4465 4264.750000 198785.9900 146123.2000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1907 1951.750000 84546.6500 0.0000
P 1220 1241.000000 50218.6000 49293.5500
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 3127 3192.750000 134765.2500 49293.5500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 271.000000 10081.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2976 4258.000000 183306.1500 0.0000
P 61 62.000000 3111.0000 3111.0000
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 3226 4591.000000 196498.3500 3111.0000