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:EIP DEI DEIP
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 11148 31667.25000 1177726.9500 37.1907
Subtotal (Total Children Is Unduplicated) 11148 31667.25000 1177726.9500 37.1907
-----------------------------------------------------------------------------------------------------------------------
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 29 52.500000 3937.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 22 38.000000 2850.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 12.500000 937.5000 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 6 10.500000 787.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 15 24.500000 1837.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 5.500000 412.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 33 60.000000 3330.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 30 54.000000 2997.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 481 884.000000 66300.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 498 884.000000 66300.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 164 288.000000 21600.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 225 390.500000 29287.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 121 219.500000 16575.0000 75.5125
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 105 185.000000 13837.5000 74.7973
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 556 981.000000 54429.0000 55.4832
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 655 1183.000000 65695.5000 55.5330
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 189 292.000000 22050.0000 75.5137
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 144 242.000000 18150.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 12 12.000000 600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 6.000000 308.4600 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 16.000000 822.5600 51.4100
Subtotal (Total Children Is Unduplicated) 1906 5879.000000 395710.9300 67.3092
-----------------------------------------------------------------------------------------------------------------------
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 2 4.000000 100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 409 1581.250000 79062.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 201 512.250000 25612.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 28.000000 2014.8800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 12 20.000000 1439.2000 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 103 329.500000 23710.8200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 50 108.000000 7771.6800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 18 44.750000 3220.2100 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 3 3.000000 215.8800 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 127 620.250000 44633.1900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 31 41.500000 2986.3400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 17 32.500000 2338.7000 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 15.000000 1079.4000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 102 327.750000 23584.8900 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 47 83.750000 6026.6500 71.9600
Subtotal (Total Children Is Unduplicated) 882 3759.500000 224136.1200 59.6186
-----------------------------------------------------------------------------------------------------------------------
Total 41305.750000 1797574.0000 43.5187
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 11601
-----------------------------------------------------------------------------------------------------------------------
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 2 2.000000 121.9600 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 660 662.250000 41056.0700 39474.9200
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 1880 3156.500000 126040.0000 0.0000
P 273 465.500000 18130.6500 17974.0500
D 108 157.250000 5877.1500 0.0000
S 2 3.750000 139.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
476 680.500000 35204.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2741 4467.500000 185540.2000 17974.0500
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
4943 3866.750000 162156.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4944 3867.250000 162175.2000 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 12 15.750000 679.2000 679.2000
D 1 2.000000 74.4000 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
2 2.000000 143.9200 0.0000
Other 16 21.000000 856.8000 0.0000
---------------------------------------------------------
Total 3130 3295.000000 134808.6800 679.2000
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 11 18.250000 1098.7500 0.0000
D 87 70.000000 2893.6500 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
318 164.500000 6093.5000 0.0000
Other 458 353.750000 13430.4000 0.0000
---------------------------------------------------------
Total 8691 7505.500000 321661.7000 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 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
1 2.000000 100.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26 27.500000 1515.2500 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
27 25.250000 1103.3000 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 2290 2187.250000 103924.9600 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
40 27.250000 961.3500 0.0000
Other 209 179.250000 9582.5200 0.0000
---------------------------------------------------------
Total 2962 2640.250000 134047.6000 86271.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 68 70.250000 4237.4400 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
18 16.500000 661.3600 0.0000
Other 153 126.750000 6535.7900 37.5000
---------------------------------------------------------
Total 4138 3779.000000 177491.9600 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
175 210.000000 11331.2400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3046 2944.750000 123866.4900 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 1 2.000000 111.0000 111.0000
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
4 5.000000 327.8200 0.0000
Other 181 189.750000 7058.7000 0.0000
---------------------------------------------------------
Total 2984 4036.750000 169143.5200 111.0000