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
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 764 3161.500000 117505.5000 37.1676
Subtotal (Total Children Is Unduplicated) 764 3161.500000 117505.5000 37.1676
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 17 34.000000 2550.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 11.000000 825.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 4.000000 300.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 19.500000 1462.5000 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 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 8.000000 600.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 7 13.000000 721.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 18.500000 1026.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 134 246.500000 18487.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 161 272.000000 20400.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 42 74.000000 5550.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 91 158.500000 11887.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 40 70.500000 5287.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 69 115.500000 8662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 158 274.500000 15207.0000 55.3989
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 245 414.000000 22977.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 52.500000 3937.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 55 94.000000 7050.0000 75.0000
Subtotal (Total Children Is Unduplicated) 619 1902.500000 128619.7500 67.6057
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Total 5064.000000 246125.2500 48.6029
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Number of Children (Unduplicated) With at Least One Service 830
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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 4 5.500000 393.0000 0.0000
H 49 58.750000 3941.5500 3941.5500
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 53 64.250000 4334.5500 3941.5500
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 251 219.750000 9829.0500 0.0000
---------------------------------------------------------
Total 251 219.750000 9829.0500 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 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
123 140.750000 5830.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 123 140.750000 5830.6500 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 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
28 35.000000 2274.0000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 146 239.500000 11166.1500 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 0 0.000000 0.0000 0.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 269 262.750000 9774.3000 6398.4000
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
189 234.750000 11543.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 189 234.750000 11543.5500 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 155 177.250000 8501.1000 8501.1000
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 5 4.250000 158.1000 0.0000
---------------------------------------------------------
Total 197 231.750000 11169.9000 8501.1000
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 4 7.750000 324.9000 361.5000
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
26 50.000000 3750.0000 0.0000
Other 51 96.500000 6769.5000 0.0000
---------------------------------------------------------
Total 284 469.750000 25744.0500 361.5000
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
5 8.000000 297.6000 0.0000
Other 3 1.750000 65.1000 0.0000
---------------------------------------------------------
Total 357 455.750000 22214.5500 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 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 75.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5 5.000000 297.0000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 3.750000 177.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 55 86.250000 4504.2000 0.0000
P 81 120.750000 6174.9000 6174.9000
D 3 6.000000 450.0000 0.0000
S 15 20.000000 1027.8000 120.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7 10.500000 654.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 164 247.250000 12988.2000 6294.9000
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 0 0.000000 0.0000 0.0000
S 2 2.250000 140.4000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
25 39.000000 2298.9000 0.0000
Other 13 13.750000 757.2000 0.0000
---------------------------------------------------------
Total 409 449.750000 21603.1500 14361.1500
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 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
31 53.000000 3314.4000 0.0000
Other 5 7.000000 466.5000 52.5000
---------------------------------------------------------
Total 553 705.500000 33044.4000 20573.4000
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 106 191.500000 9192.0000 8379.7500
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
93 188.750000 12511.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 349 646.750000 34741.5000 8379.7500
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
1 1.000000 75.0000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 369 690.750000 31844.2500 0.0000