CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 1.000000 37.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21538 140130.6183 5201967.3600 37.1223
Subtotal (Total Children Is Unduplicated) 21538 140131.6183 5202004.5600 37.1223
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 89 176.000000 13161.0000 74.7784
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 108 192.000000 14362.5000 74.8047
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 21.000000 1575.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 65 115.500000 8662.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 43.000000 3225.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 51 91.000000 6825.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 33 61.500000 4612.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 27 50.000000 3750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 69 136.000000 7520.2500 55.2960
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 187 343.000000 19036.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1772 3294.410000 246966.7500 74.9654
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2198 3857.000000 288705.0000 74.8522
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 385 669.000000 50137.5000 74.9439
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1160 1963.000000 147141.0000 74.9572
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 534 990.500000 74250.0000 74.9621
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 721 1232.500000 92437.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1880 3481.000000 193112.2500 55.4761
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3338 5929.000000 328931.7000 55.4784
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 747 1233.500000 92275.0000 74.8075
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 601 1052.000000 78900.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 12 12.000000 909.5300 75.7942
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.8200 51.4100
SCREEN-T1023-SCREENING 89 90.000000 4500.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 154.2300 51.4100
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92521TL-EVAL OF SPEECH FLUENCY 2 3.000000 154.2300 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 5.000000 255.9700 51.1940
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 22 23.000000 1182.0700 51.3943
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 6 7.000000 359.8700 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 1 1.000000 52.5700 52.5700
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 13 78.000000 4121.1800 52.8356
Subtotal (Total Children Is Unduplicated) 8471 25168.91000 1688072.0100 67.0697
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 711 5917.000000 295800.0000 49.9915
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 481 2039.000000 101918.5000 49.9846
OCCT-97530-OT SESSION BY LICENSED OT 51 138.680000 9965.9100 71.8626
OCCT-97530GT-OT SESSION BY LICENSED OT 17 33.250000 2391.1100 71.9131
OCCT-97530HM-OT SESSION BY OT ASST 5 16.250000 934.8000 57.5262
OCCT-97530TL-OT SESSION BY LICENSED OT 144 1115.000000 80001.8600 71.7505
OCCT-97530TLGT-OT SESSION BY LICENSED OT 104 399.000000 28664.9800 71.8421
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 45 178.500000 12830.3000 71.8784
PHY-97110GT-PT SESSION BY LICENSED PT 3 6.000000 430.2000 71.7000
PHY-97110TL-PT SESSION BY LICENSED PT 192 1735.000000 124615.0700 71.8242
PHY-97110TLGT-PT SESSION BY LICENSED PT 75 148.750000 10677.5300 71.7817
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 57 167.000000 11770.3300 70.4810
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 32.750000 2355.1300 71.9124
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 238 1970.710000 141497.2700 71.8001
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 108 397.250000 28540.6100 71.8455
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.9600 13.9600
Subtotal (Total Children Is Unduplicated) 1565 14296.14000 852465.1600 59.6290
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Total 179596.668280 7742541.7300 43.1107
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Number of Children (Unduplicated) With at Least One Service 21843
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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 14 14.000000 551.5600 551.5600
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 14 14.000000 551.5600 551.5600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 107 145.500000 5412.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 6184 4286.000000 165996.2400 0.0000
P 2910 2029.750000 80467.5500 80281.4800
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 9201 6461.250000 251876.3900 80281.4800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 210 326.500000 12902.5500 0.0000
U 0 0.000000 0.0000 0.0000
B 5978 8978.500000 357464.0500 0.0000
P 7138 11391.000000 455718.6000 450651.3300
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 13326 20696.000000 826085.2000 450651.3300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 23.500000 874.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 12388 7764.250000 288411.0000 236329.9100
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 12428 7787.750000 289285.2000 236329.9100
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 90 70.750000 3083.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 1989 1666.750000 75993.6000 0.0000
P 10000 8525.500000 373736.3600 373464.1200
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 12079 10263.000000 452813.0600 373464.1200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 199 200.250000 7828.5400 0.0000
U 0 0.000000 0.0000 0.0000
B 8558 9225.750000 375548.3300 5517.5100
P 8609 9350.500000 376139.5600 374837.8500
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 17366 18776.500000 759516.4300 380355.3600
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 99 80.250000 3154.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 39699 34861.750000 1469478.0000 0.0000
P 222 295.750000 16375.7500 408.5000
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 40020 35237.750000 1489007.9500 408.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.500000 138.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 40 55.000000 3453.7500 0.0000
P 1 4.000000 200.0000 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 43 61.500000 3792.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 13.000000 685.6200 0.0000
U 0 0.000000 0.0000 0.0000
B 1969 2018.750000 108979.3200 130.2000
P 7117 7553.000000 354262.8600 474129.2400
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 9099 9584.750000 463927.8000 474259.4400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 186 188.500000 13240.8100 0.0000
U 0 0.000000 0.0000 0.0000
B 1410 1296.250000 64434.8600 0.0000
P 12392 11552.960000 573743.3500 573543.5600
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 13988 13037.710000 651419.0200 573543.5600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.000000 520.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2503 2401.250000 114818.0200 0.0000
P 20940 19366.180000 891041.8500 890153.5900
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 23455 21781.430000 1006380.6700 890153.5900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3824 3868.703067 177195.0800 0.0000
P 10289 10237.706933 437675.1700 437140.5600
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 14113 14106.410000 614870.2500 437140.5600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 25 44.500000 1954.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 4785 6949.750000 303470.9000 139.5000
P 9987 14794.368280 627590.6000 627065.2260
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 14797 21788.618280 933015.7000 627204.7260