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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 790 962.750000 35814.3000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 150 171.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1370 6379.250000 237047.7000 37.1592
Subtotal (Total Children Is Unduplicated) 1398 7513.250000 272862.0000 36.3174
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Screening, Eval, and Assessment,Class #02
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 8.000000 400.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 38.500000 2887.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 25.000000 1875.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 20 34.500000 2587.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.000000 1200.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 13 24.000000 1332.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 25 41.000000 2275.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 274 508.000000 37591.1400 73.9983
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 345 568.000000 42600.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 111 199.000000 15037.5000 75.5653
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 194 324.000000 24300.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 93 174.000000 12720.4000 73.1057
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 129 213.500000 16012.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 343 607.000000 33633.0000 55.4086
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 505 846.500000 46980.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 78 136.000000 10150.0000 74.6324
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 102 179.500000 13462.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 15 15.000000 2053.6500 136.9100
Subtotal (Total Children Is Unduplicated) 1247 3999.500000 270248.9400 67.5707
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EI Services,Class #03
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 2 2.000000 100.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1 2.000000 100.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 1 2.000000 50.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 47 91.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 10.000000 500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 34 40.000000 600.0000 15.0000
INTR-T1013-INTERPRETER 33 76.000000 3845.0000 50.5921
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 70 96.000000 1152.0000 12.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 0.250000 21.7900 87.1600
TRAV-TRAVS-Travel by mile 138 4764.000000 2118.9200 0.4448
Subtotal (Total Children Is Unduplicated) 233 5087.750000 8712.7100 1.7125
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Total 16600.500000 551823.6500 33.2414
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Number of Children (Unduplicated) With at Least One Service 1534
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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 31 153.500000 1872.2100 1872.2100
D 1 1.500000 83.2500 0.0000
S 5 7.000000 468.0000 75.0000
H 66 81.250000 5512.0500 3941.5500
T 9 26.750000 544.6200 544.6200
11 17.500000 1244.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 123 287.500000 9724.3800 6433.3800
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 46 1113.000000 3212.4100 3212.4100
15 277.500000 902.8700 0.0000
Other 759 1739.500000 21663.3000 0.0000
---------------------------------------------------------
Total 820 3130.000000 25778.5800 3212.4100
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 53 172.000000 4975.3200 4975.3200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 35.000000 2290.2400 2290.2400
T 0 0.000000 0.0000 0.0000
203 256.250000 10189.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 276 463.250000 17455.2100 7265.5600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 93 150.250000 6657.6000 0.0000
P 21 48.000000 2002.0500 1775.0500
D 3 5.500000 204.6000 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
277 387.750000 20312.1000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 395 592.250000 29204.2500 1775.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 13.000000 483.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 258 249.000000 9262.8000 6398.4000
P 146 1537.000000 6439.1300 6439.1300
D 1 0.750000 27.9000 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
396 343.000000 8427.8000 299.6000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 811 2142.750000 24641.2300 13137.1300
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
539 579.750000 28167.6000 0.0000
Other 2 2.000000 130.5000 0.0000
---------------------------------------------------------
Total 541 581.750000 28298.1000 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 37 50.250000 2510.7000 0.0000
P 222 309.250000 12059.9000 12059.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
405 335.000000 13275.0000 0.0000
Other 11 10.000000 447.6000 0.0000
---------------------------------------------------------
Total 676 706.500000 28443.2000 12059.9000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 10.000000 372.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 195 305.500000 14527.6500 0.0000
P 370 477.000000 21515.3000 21551.9000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 141 183.000000 10258.9500 0.0000
T 21 26.750000 1598.7000 1598.7000
96 160.750000 9897.2000 0.0000
Other 71 134.000000 9367.5000 0.0000
---------------------------------------------------------
Total 902 1297.000000 67537.3000 23150.6000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 12.750000 727.6500 0.0000
U 0 0.000000 0.0000 0.0000
B 337 427.250000 20713.2000 0.0000
P 0 0.000000 0.0000 0.0000
D 3 6.000000 411.0000 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
360 486.250000 25401.4500 0.0000
Other 3 1.750000 65.1000 0.0000
---------------------------------------------------------
Total 712 934.000000 47318.4000 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 4 4.000000 222.0000 0.0000
P 6 5.250000 168.7900 168.7900
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
2 2.000000 130.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 11.250000 521.2900 168.7900
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.750000 177.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 56 87.500000 4550.7000 0.0000
P 89 135.750000 7048.8600 6995.3200
D 12 24.000000 1800.0000 0.0000
S 15 20.000000 1027.8000 120.0000
H 10 20.000000 1500.0000 0.0000
T 48 408.500000 2381.0400 2287.0400
184 258.500000 9800.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 417 958.000000 28285.9500 9402.3600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 13.750000 738.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 60 67.250000 3307.2000 0.0000
P 296 313.750000 14361.1500 14361.1500
D 12 16.500000 977.2500 0.0000
S 2 2.250000 140.4000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 8.500000 471.7500 416.2500
519 402.000000 17616.1500 0.0000
Other 13 13.750000 757.2000 0.0000
---------------------------------------------------------
Total 922 837.750000 38369.4000 14777.4000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 5.500000 280.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 129 172.250000 8462.4000 0.0000
P 385 467.750000 20520.9000 20520.9000
D 6 10.000000 484.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.500000 187.5000 0.0000
T 31 107.000000 2312.3600 2312.3600
515 619.000000 23639.4500 0.0000
Other 5 7.000000 466.5000 52.5000
---------------------------------------------------------
Total 1076 1391.000000 56353.5100 22885.7600
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 150 266.500000 13038.0000 0.0000
P 114 206.250000 10074.9000 9262.6500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 38.000000 2750.0000 0.0000
T 0 0.000000 0.0000 0.0000
788 875.250000 40812.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1071 1386.000000 66675.7000 9262.6500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 25.000000 930.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 355 664.000000 30811.3500 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
478 1191.750000 51447.9000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 846 1881.500000 83217.1500 0.0000