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
Agency Filter:EXT
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 75 85.500000 3180.6000 37.2000
Subtotal (Total Children Is Unduplicated) 75 85.500000 3180.6000 37.2000
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 4 7.500000 562.5000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 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 2 3.500000 194.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 40.000000 3000.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 59 114.000000 8530.0000 74.8246
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 13 26.000000 1950.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 64 121.000000 9075.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 80.500000 6037.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 32 63.500000 3524.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 85 158.500000 8796.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 4.000000 300.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 52.500000 3937.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 3 3.000000 154.2300 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 19 19.000000 976.7900 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 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-97167-OT EVAL HIGH COMPLEXITY 10 10.000000 514.1000 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 20 20.000000 1028.2000 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 6 6.000000 262.5000 43.7500
SPCH-92521-EVAL OF SPEECH FLUENCY 23 23.000000 1182.4300 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 7 7.000000 359.8700 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 5 5.000000 257.0500 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 5.000000 264.6500 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 410 832.000000 55043.7700 66.1584
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 24.000000 600.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4160 23958.75000 1197561.5000 49.9843
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 776 3033.000000 151700.0000 50.0165
OCCT-97530-OT SESSION BY LICENSED OT 361 1503.500000 108133.5800 71.9212
OCCT-97530GT-OT SESSION BY LICENSED OT 31 66.500000 4785.3400 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 29 101.500000 7303.9400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 2.000000 143.9200 71.9600
OCCT-97530TLHM-OT SESSION BY OT ASST 5 9.000000 518.4000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 338 1235.250000 88828.6300 71.9115
PHY-97110GT-PT SESSION BY LICENSED PT 14 23.000000 1647.8800 71.6470
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 12 32.750000 2356.6900 71.9600
PHY-97110TLHM-PT SESSION BY PT ASST 7 34.750000 2043.4100 58.8032
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 469 2350.500000 168836.1500 71.8299
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 50 132.500000 9534.7000 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 40 111.500000 8023.5400 71.9600
Subtotal (Total Children Is Unduplicated) 5514 33901.75000 1825991.8700 53.8613
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Total 34819.250000 1884216.2400 54.1142
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Number of Children (Unduplicated) With at Least One Service 5834
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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 35 36.500000 2038.9300 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 38 39.500000 2188.9300 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 99 76.250000 2836.5000 0.0000
P 4 8.000000 506.1600 74.4000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1497 5808.500000 292047.2100 0.0000
T 0 0.000000 0.0000 0.0000
28 44.000000 1842.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1628 5936.750000 297232.5900 74.4000
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
4428 4380.250000 223940.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4428 4380.250000 223940.5300 0.0000
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 132 132.000000 7149.0000 7149.0000
D 51 51.000000 2550.0000 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
3335 3382.500000 183391.1500 0.0000
Other 120 236.000000 16793.2500 0.0000
---------------------------------------------------------
Total 3638 3801.500000 209883.4000 7149.0000
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 3 6.000000 409.8000 133.0000
D 1 1.000000 50.0000 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
4053 9502.750000 536026.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4061 9516.250000 536931.7800 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 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
374 1154.250000 71952.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 374 1154.250000 71952.7600 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 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
867 880.000000 50065.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 867 880.000000 50065.8100 0.0000
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 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
814 848.500000 46532.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 814 848.500000 46532.9600 0.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 71.9600 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
967 1015.250000 52847.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 968 1016.250000 52919.6300 0.0000
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2524 2571.250000 157007.3800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2524 2571.250000 157007.3800 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 60 60.000000 3000.0000 3000.0000
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
4611 4598.750000 231785.4700 231712.8300
Other 1 1.000000 25.0000 25.0000
---------------------------------------------------------
Total 4687 4674.750000 235560.4700 235452.8300