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:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 2 0.750000 27.9000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 65 122.250000 4547.7000 37.2000
Subtotal (Total Children Is Unduplicated) 65 123.000000 4575.6000 37.2000
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Screening, Eval, and Assessment,Class #02
EXIT-EXIT-COS Exit 1 0.500000 25.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 9 20.500000 1372.7000 66.9610
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 14 28.500000 2137.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 5.000000 375.0000 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 6 11.000000 610.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 19 36.000000 1998.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 219 449.666666 33165.8000 73.7564
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 221 419.000000 31260.2000 74.6067
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 84 169.909600 12704.2200 74.7705
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 122 229.500000 17212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 67 130.466700 9755.0025 74.7701
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 39 73.500000 5512.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 162 315.000000 17482.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 248 469.500000 26057.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 107 181.000000 13575.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 48 85.547000 6416.0250 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 13 13.000000 3952.0000 304.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 7 17.000000 899.8100 52.9300
Subtotal (Total Children Is Unduplicated) 861 2709.589966 188254.8375 69.4772
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 84.8200 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 451.7600 64.5371
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 6 7.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 10 12.500000 625.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 173 703.250000 35052.0000 49.8429
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 37 63.000000 3150.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 51 203.500000 14643.8600 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 27 60.250000 4423.6300 73.4212
OCCT-97530TL-OT SESSION BY LICENSED OT 3 4.000000 287.8400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 80 333.250000 24677.4900 74.0510
PHY-97110GT-PT SESSION BY LICENSED PT 14 16.000000 1151.3600 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 143.9200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 114 436.000000 31006.2400 71.1152
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 23 45.000000 3238.2000 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 8 18.000000 1295.2800 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 0.500000 35.9800 71.9600
Subtotal (Total Children Is Unduplicated) 433 1917.250000 120454.3400 62.8266
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Total 4749.839966 313284.7775 65.9569
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Number of Children (Unduplicated) With at Least One Service 1295
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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 0 0.000000 0.0000 0.0000
H 307 346.250000 21753.9600 0.0000
T 0 0.000000 0.0000 0.0000
146 156.500000 10001.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 453 502.750000 31755.5600 0.0000
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 1 1.000000 20.0000 20.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 20.0000 20.0000
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
1 0.750000 27.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.750000 27.9000 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 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
100 130.000000 12551.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 100 130.000000 12551.5000 0.0000
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
298 437.750000 28167.6500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 298 437.750000 28167.6500 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 0 0.000000 0.0000 0.0000
P 4 3.923300 294.2475 294.2400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
66 125.750000 9270.9000 0.0000
Other 6 12.000000 900.0000 0.0000
---------------------------------------------------------
Total 79 147.673300 10915.1475 294.2400
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 50 50.750000 1887.9000 1887.9000
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
106 182.500000 12033.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 156 233.250000 13921.7300 1887.9000
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 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
463 936.750000 63783.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 463 936.750000 63783.1500 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 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
1 1.500000 83.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.500000 83.2500 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 66 74.750000 4915.1000 3879.1300
D 59 61.750000 4500.6100 0.0000
S 1 0.750000 27.9000 0.0000
H 80 103.250000 7543.8100 48.0000
T 374 394.250000 20914.7700 15724.7000
263 291.250000 16600.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 843 926.000000 54502.6000 19651.8300
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 1 1.000000 71.9600 71.9600
D 82 101.750000 6190.9800 0.0000
S 1 2.000000 150.0000 0.0000
H 134 137.000000 9852.6000 0.0000
T 1 2.000000 111.0000 0.0000
218 230.750000 15454.7100 0.0000
Other 2 2.000000 143.9200 0.0000
---------------------------------------------------------
Total 439 476.500000 31975.1700 71.9600
Center 54
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 7 7.000000 1360.0000 731.1000
D 89 89.000000 5811.2400 0.0000
S 2 2.000000 143.9200 0.0000
H 119 121.000000 8455.8000 0.0000
T 0 0.000000 0.0000 0.0000
312 351.750000 23348.4100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 529 570.750000 39119.3700 731.1000
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 41 79.000000 5915.8800 0.0000
T 0 0.000000 0.0000 0.0000
34 42.666666 3133.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 75 121.666666 9049.0000 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 0 0.000000 0.0000 0.0000
D 2 4.000000 261.0000 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
144 259.500000 17151.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 146 263.500000 17412.7500 0.0000