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
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 10052 29046.75000 1080262.5500 37.1905
Subtotal (Total Children Is Unduplicated) 10052 29046.75000 1080262.5500 37.1905
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 103.3600
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 37 65.500000 4912.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 26 46.500000 3487.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 21.000000 1575.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 19.500000 1462.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 7 12.000000 900.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 27.000000 1950.0000 72.2222
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 35 66.500000 3729.7500 56.0865
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 37.500000 2081.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 556 1009.000000 75712.5000 75.0372
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 352 626.500000 46958.2500 74.9533
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 153 279.000000 20962.5000 75.1344
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 197 344.000000 25800.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 174 292.500000 22125.0000 75.6410
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 92 166.500000 12562.5000 75.4505
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 642 1147.000000 63486.4500 55.3500
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 476 834.500000 46326.0000 55.5135
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 196 357.500000 26725.8000 74.7575
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 168 291.500000 21862.5000 75.0000
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
SCREEN-T1023-SCREENING 14 14.000000 800.0000 57.1429
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 6 6.000000 308.4600 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 18.000000 925.3800 51.4100
Subtotal (Total Children Is Unduplicated) 1850 5715.000000 387130.4300 67.7394
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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 397 1579.250000 78962.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 136 321.500000 16100.0000 50.0778
OCCT-97530-OT SESSION BY LICENSED OT 12 22.500000 1619.1000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 107 323.730000 23294.2300 71.9557
OCCT-97530TLGT-OT SESSION BY LICENSED OT 44 113.500000 8131.4800 71.6430
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 10 18.000000 1295.2800 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.000000 71.9600 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 114 491.750000 35386.3300 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 28 31.500000 2266.7400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 13 33.650000 2421.3700 71.9575
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 4 5.980000 429.9400 71.8963
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 94 325.640000 23431.7200 71.9559
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 27 55.250000 3975.7900 71.9600
Subtotal (Total Children Is Unduplicated) 788 3339.250000 198205.5300 59.3563
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Total 38101.000000 1665598.5100 43.7153
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Number of Children (Unduplicated) With at Least One Service 10573
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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 13 13.000000 894.3800 0.0000
H 558 750.500000 49656.9700 49656.9700
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 571 763.500000 50551.3500 49656.9700
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 405 293.750000 12610.6600 0.0000
---------------------------------------------------------
Total 405 293.750000 12610.6600 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
1603 1129.750000 43234.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1603 1129.750000 43234.9000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 89 159.500000 6597.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 1238 2154.000000 84392.2500 0.0000
P 591 993.750000 38378.6000 37964.3500
D 21 37.750000 1404.3000 0.0000
S 1 0.250000 9.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
254 317.000000 20811.1500 0.0000
Other 14 19.500000 725.4000 0.0000
---------------------------------------------------------
Total 2208 3681.750000 152318.4500 37964.3500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2062 1247.750000 46416.3000 23724.3800
P 0 0.000000 0.0000 0.0000
D 1 0.250000 9.3000 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 65 51.000000 1897.2000 0.0000
---------------------------------------------------------
Total 2155 1317.500000 49011.0000 23724.3800
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
4739 3952.250000 166302.4500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4739 3952.250000 166302.4500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 706 597.500000 27861.5000 0.0000
P 1697 1370.250000 61458.7500 61421.5500
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
3 2.500000 93.0000 0.0000
Other 46 22.500000 837.0000 0.0000
---------------------------------------------------------
Total 2510 2029.500000 91617.3500 61421.5500
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1879 2015.250000 83316.7500 83316.7500
T 0 0.000000 0.0000 0.0000
266 298.250000 12992.4500 130.2000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 2146 2313.750000 96318.5000 83446.9500
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8349 7346.000000 314934.4500 0.0000
P 6 10.500000 748.5000 0.0000
D 14 10.750000 399.9000 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
283 145.250000 5403.3000 0.0000
Other 400 291.750000 10965.3000 0.0000
---------------------------------------------------------
Total 9099 7837.000000 333669.7500 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 8 7.000000 388.5000 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 1.000000 55.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 8.000000 444.0000 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 610 623.500000 32054.2400 109.1600
P 1284 1258.000000 59629.5600 59465.2200
D 0 0.000000 0.0000 0.0000
S 186 181.250000 7555.5000 180.0200
H 0 0.000000 0.0000 0.0000
T 1 0.500000 18.6000 0.0000
65 55.500000 2314.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2190 2160.000000 103757.2600 59754.4000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 453 415.500000 22439.1400 0.0000
P 2321 2156.000000 107973.2500 107945.0500
D 18 17.250000 902.0000 0.0000
S 110 113.630000 4597.2900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
85 60.500000 2414.4800 0.0000
Other 141 110.750000 5089.1000 203.7000
---------------------------------------------------------
Total 3155 2896.880000 144318.5600 108148.7500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 899.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 565 527.250000 24092.0900 0.0000
P 3305 2940.500000 134231.4100 134227.9100
D 1 0.500000 18.6000 0.0000
S 19 18.140000 1242.5300 0.0000
H 7 5.480000 392.9600 0.0000
T 0 0.000000 0.0000 0.0000
20 23.500000 940.3600 0.0000
Other 106 86.250000 4102.3800 0.0000
---------------------------------------------------------
Total 4050 3624.870000 165919.9900 134227.9100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1634 1515.750000 65684.4400 0.0000
P 1091 982.500000 39542.1000 38607.6000
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
2 6.000000 223.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2727 2504.250000 105449.7400 38607.6000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1532 2266.000000 98783.1000 0.0000
P 11 17.500000 1127.2500 1127.2500
D 0 0.000000 0.0000 0.0000
S 4 5.500000 354.0000 0.0000
H 249 361.750000 13457.1000 13457.1000
T 1 1.500000 83.2500 83.2500
498 716.250000 28095.1500 0.0000
Other 214 219.750000 8174.7000 0.0000
---------------------------------------------------------
Total 2509 3588.250000 150074.5500 14667.6000