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: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 11199 31752.75000 1180907.5500 37.1907
Subtotal (Total Children Is Unduplicated) 11199 31752.75000 1180907.5500 37.1907
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 310.0800 103.3600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 30 54.500000 4087.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 26 45.500000 3412.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 14.500000 1087.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 7.500000 562.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 14.500000 1087.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 17 27.500000 2062.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 66.000000 3663.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 32 57.500000 3191.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 502 924.000000 69300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 556 998.000000 74830.0000 74.9800
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 177 314.000000 23550.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 287 511.500000 38362.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 131 239.500000 18075.0000 75.4697
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 146 265.500000 19875.0000 74.8588
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 588 1044.500000 57953.2500 55.4842
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 740 1341.500000 74492.2500 55.5291
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 193 296.000000 22350.0000 75.5068
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 172 294.500000 22087.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 21 21.000000 1079.6100 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 11 11.000000 565.5100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 22 22.000000 1131.0200 51.4100
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 4.000000 205.6400 51.4100
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 18 18.000000 862.5000 47.9167
SPCH-92521-EVAL OF SPEECH FLUENCY 25 25.000000 1285.2500 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 13.000000 668.3300 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 5.000000 264.6500 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 6 17.000000 873.9700 51.4100
Subtotal (Total Children Is Unduplicated) 2085 6711.000000 450754.7000 67.1665
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 5 5.000000 212.0500 42.4100
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 3.000000 127.2300 42.4100
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 28.000000 700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4560 25540.00000 1276624.0000 49.9853
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 977 3545.250000 177312.5000 50.0141
OCCT-97530-OT SESSION BY LICENSED OT 378 1531.500000 110148.4600 71.9219
OCCT-97530GT-OT SESSION BY LICENSED OT 43 86.500000 6224.5400 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 153 831.500000 47973.3600 57.6950
OCCT-97530HMGT-OT SESSION BY OT ASST 5 7.000000 403.1600 57.5943
OCCT-97530TL-OT SESSION BY LICENSED OT 130 431.000000 31014.7600 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 51 110.000000 7915.6000 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 5 9.000000 518.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 356 1280.000000 92048.8400 71.9132
PHY-97110GT-PT SESSION BY LICENSED PT 17 26.000000 1863.7600 71.6831
PHY-97110HM-PT SESSION BY PT ASST 84 378.000000 21754.1000 57.5505
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 12 31.250000 1798.7700 57.5606
PHY-97110TL-PT SESSION BY LICENSED PT 139 653.000000 46989.8800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 31 41.500000 2986.3400 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 7 34.750000 2043.4100 58.8032
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 486 2383.000000 171174.8500 71.8317
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 147.500000 10614.1000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 31.000000 1785.6000 57.6000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 2 4.500000 259.2000 57.6000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 142 439.250000 31608.4300 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 47 83.750000 6026.6500 71.9600
Subtotal (Total Children Is Unduplicated) 6357 37661.25000 2050127.9900 54.4360
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Total 76125.000000 3681790.2400 48.3651
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Number of Children (Unduplicated) With at Least One Service 13011
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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 37 38.500000 2160.8900 0.0000
S 20 20.500000 1459.1900 0.0000
H 623 631.250000 39158.7200 39158.7200
T 0 0.000000 0.0000 0.0000
15 8.500000 316.2000 316.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 698 701.750000 43245.0000 39624.9200
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 1458 974.500000 41127.8200 0.0000
---------------------------------------------------------
Total 1458 974.500000 41127.8200 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
1770 1215.250000 47454.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1770 1215.250000 47454.0000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1979 3232.750000 128876.5000 0.0000
P 277 473.500000 18636.8100 18048.4500
D 108 157.250000 5877.1500 0.0000
S 2 3.750000 139.5000 0.0000
H 1497 5808.500000 292047.2100 0.0000
T 0 0.000000 0.0000 0.0000
504 724.500000 37046.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4369 10404.250000 482772.7900 18048.4500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 74 55.750000 2073.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 2443 1473.250000 54804.9000 39813.3000
P 0 0.000000 0.0000 0.0000
D 15 8.500000 316.2000 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
3 1.000000 37.2000 0.0000
Other 53 34.500000 1283.4000 0.0000
---------------------------------------------------------
Total 2588 1573.000000 58515.6000 39813.3000
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
9371 8247.000000 386097.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9372 8247.500000 386115.7300 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 818 730.250000 35573.5000 0.0000
P 1637 1308.750000 55910.6500 55910.6500
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
6 7.500000 354.6000 0.0000
Other 105 64.000000 2680.8000 0.0000
---------------------------------------------------------
Total 2597 2130.000000 95244.9500 55910.6500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 95 88.500000 3447.6800 0.0000
U 0 0.000000 0.0000 0.0000
B 3004 3165.750000 129606.6800 0.0000
P 144 147.750000 7828.2000 7828.2000
D 52 53.000000 2624.4000 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
3337 3384.500000 183535.0700 0.0000
Other 136 257.000000 17650.0500 0.0000
---------------------------------------------------------
Total 6768 7096.500000 344692.0800 7828.2000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 313 262.000000 9858.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 7504 6637.000000 288286.8000 0.0000
P 14 24.250000 1508.5500 133.0000
D 88 71.000000 2943.6500 0.0000
S 4 6.500000 445.7800 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4371 9667.250000 542119.7000 0.0000
Other 458 353.750000 13430.4000 0.0000
---------------------------------------------------------
Total 12752 17021.750000 858593.4800 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 25 25.500000 1415.2500 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
375 1156.250000 72052.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 400 1181.750000 73468.0100 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 30.250000 1808.8200 0.0000
U 0 0.000000 0.0000 0.0000
B 807 767.250000 36200.8600 50.0000
P 1269 1222.500000 59058.4800 59008.6800
D 8 5.750000 289.5000 0.0000
S 147 136.000000 5454.7000 177.2000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
894 905.250000 51169.1100 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 3157 3067.250000 153990.7700 59245.1800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 51.000000 3019.6500 0.0000
U 0 0.000000 0.0000 0.0000
B 676 604.000000 31641.9800 0.0000
P 1933 1741.750000 86286.9400 86271.3800
D 4 3.000000 146.3600 0.0000
S 30 31.000000 2192.9200 0.0000
H 3 3.000000 215.8800 0.0000
T 0 0.000000 0.0000 0.0000
854 875.750000 47494.3100 0.0000
Other 209 179.250000 9582.5200 0.0000
---------------------------------------------------------
Total 3776 3488.750000 180580.5600 86271.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 69 71.250000 4309.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 878 845.750000 39518.5000 109.1600
P 3001 2702.250000 125694.5900 125493.1400
D 0 0.000000 0.0000 0.0000
S 9 7.000000 381.1200 0.0000
H 11 10.500000 463.1600 0.0000
T 0 0.000000 0.0000 0.0000
985 1031.750000 53509.0300 0.0000
Other 153 126.750000 6535.7900 37.5000
---------------------------------------------------------
Total 5106 4795.250000 230411.5900 125639.8000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1757 1685.250000 71508.6500 0.0000
P 1114 1049.500000 41026.6000 40913.8000
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
2699 2781.250000 168338.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5570 5516.000000 280873.8700 40913.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 177 246.000000 9151.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2621 3594.000000 152494.8000 0.0000
P 61 62.000000 3111.0000 3111.0000
D 0 0.000000 0.0000 0.0000
S 11 11.000000 550.0000 550.0000
H 0 0.000000 0.0000 0.0000
T 4 4.000000 200.0000 165.0000
4615 4603.750000 232113.2900 231712.8300
Other 182 190.750000 7083.7000 25.0000
---------------------------------------------------------
Total 7671 8711.500000 404703.9900 235563.8300