CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 Page: 1
List order: No List
Payclass Filters:MED
Bill Flag Filter:RBPU
Eligibility Filter:All
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 7230 22339.75000 830762.1500 37.1876
Subtotal (Total Children Is Unduplicated) 7230 22339.75000 830762.1500 37.1876
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Screening, Eval, and Assessment,Class #02
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 72.000000 5400.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 18 34.000000 2550.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 18.500000 1387.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 14.500000 1087.5000 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 12 23.500000 1687.5000 71.8085
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 8.000000 600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 74.000000 4146.0000 56.0270
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 18 33.000000 1831.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 628 1147.500000 86100.0000 75.0327
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 219 389.500000 29212.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 131 239.000000 17962.5000 75.1569
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 138 246.000000 18450.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 182 293.000000 22162.5000 75.6399
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 74 132.000000 9900.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 598 1075.000000 59518.2000 55.3658
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 306 539.000000 29859.0000 55.3970
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 134 237.500000 17725.8000 74.6349
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 95 165.000000 12375.0000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 10 10.000000 600.0000 60.0000
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 3 15.000000 771.1500 51.4100
Subtotal (Total Children Is Unduplicated) 1540 4799.500000 325683.5600 67.8578
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 1 1.000000 42.4100 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 351 1449.250000 72462.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 87 224.000000 11225.0000 50.1116
OCCT-97530-OT SESSION BY LICENSED OT 3 5.000000 359.8000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 85 249.500000 17954.0200 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 33 83.500000 5972.6800 71.5291
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 8 14.000000 1007.4400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 98 430.750000 30996.7700 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 26 29.500000 2122.8200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 6.750000 485.7300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 143.9200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 90 317.000000 22811.3200 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 24 50.250000 3615.9900 71.9600
Subtotal (Total Children Is Unduplicated) 653 2879.500000 170063.5600 59.0601
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Total 30018.750000 1326509.2700 44.1894
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Number of Children (Unduplicated) With at Least One Service 7476
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Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 89 159.500000 6597.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 1379 2309.250000 90570.0000 0.0000
P 674 1089.250000 42123.4600 41388.0500
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2142 3558.000000 139290.9100 41388.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2281 1451.500000 53995.8000 27369.9800
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2308 1470.000000 54684.0000 27369.9800
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 59 38.750000 1478.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 746 642.500000 30023.3000 0.0000
P 1806 1516.250000 68521.9500 68484.7500
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2611 2197.500000 100023.3500 68484.7500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8893 8006.750000 347005.3500 0.0000
P 17 25.500000 1528.9000 132.0000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8957 8065.000000 349752.5500 132.0000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.000000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 10 9.000000 527.2500 0.0000
P 1 2.000000 100.0000 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 12.000000 682.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 642 667.500000 34253.8400 174.2600
P 1357 1366.250000 65144.7600 64980.4200
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2043 2075.000000 101583.2600 65154.6800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 486 451.500000 24329.7000 0.0000
P 2528 2392.000000 119122.6000 119094.4000
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3041 2866.750000 144355.6000 119094.4000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 33 29.000000 1113.5600 0.0000
U 0 0.000000 0.0000 0.0000
B 627 608.750000 27687.8900 0.0000
P 3735 3494.250000 159558.6100 159555.1100
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4395 4132.000000 188360.0600 159555.1100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1806 1833.000000 82203.0400 0.0000
P 1177 1145.500000 47371.5000 45595.5000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2983 2978.500000 129574.5400 45595.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1739 2640.500000 116664.0000 0.0000
P 16 23.500000 1538.2500 1538.2500
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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1755 2664.000000 118202.2500 1538.2500