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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 3343 4480.750000 166357.6000 37.1272
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 473 497.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 5772 30549.25000 1134580.9500 37.1394
Subtotal (Total Children Is Unduplicated) 5804 35527.75000 1300938.5500 36.6175
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 19 72.000000 3600.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 6.000000 300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 2 3.000000 150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 75 150.000000 11212.5000 74.7500
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 81 132.500000 9900.0000 74.7170
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 19 34.500000 2587.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 55 94.000000 7050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 33 60.500000 4537.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 34 58.500000 4387.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 28 50.000000 3750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 26 49.000000 3675.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 88 150.000000 8325.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 134 238.000000 13209.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1096 2036.500297 150906.4525 74.1009
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1532 2550.500000 190419.0000 74.6595
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 318 558.499999 41372.1100 74.0772
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 849 1408.500000 105458.8100 74.8731
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 357 654.499999 48618.2500 74.2830
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 659 1076.500000 80505.2300 74.7842
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1395 2512.500000 139138.5000 55.3785
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 2418 4052.500000 224511.5000 55.4007
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 450 768.000000 57378.7600 74.7119
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 560 1005.000000 75097.1400 74.7235
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 68 68.000000 9223.9900 135.6469
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 193.0000 193.0000
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 5219 17797.00030 1195858.1525 67.1944
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 5 6.250000 312.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 2 2.000000 100.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 2 1.750000 43.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 1.000000 50.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 4 4.250000 212.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 1 0.500000 12.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 2 0.750000 37.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1 0.500000 25.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 2 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 2 2.500000 125.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 4 4.750000 237.5000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 192 206.749700 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 8.000000 400.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 11 129.500000 6475.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 7 40.500000 2025.0000 50.0000
INTR-T1013-INTERPRETER 148 359.750000 17261.0000 47.9805
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 434 917.000000 9176.0000 10.0065
OCCT-97530-OT SESSION BY LICENSED OT 1 9.000000 647.6400 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 1 21.000000 1510.6400 71.9352
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 2.000000 143.4000 71.7000
PHY-97110TL-PT SESSION BY LICENSED PT 1 5.000000 357.2000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.750000 53.8400 71.7867
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 2 1.250000 46.2500 37.0000
TRAV-TRAVS-Travel by mile 488 20524.00000 9100.2300 0.4434
Subtotal (Total Children Is Unduplicated) 916 22250.74970 48474.4100 2.1786
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Total 75575.499995 2545271.1125 33.6785
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Number of Children (Unduplicated) With at Least One Service 5955
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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 386 1376.750000 20370.3600 20370.3600
D 9 92.750000 343.6000 0.0000
S 9 11.000000 594.7500 0.0000
H 2164 2008.500000 95206.8000 80164.0500
T 60 242.500000 4182.6100 4182.6100
1418 1107.000000 44927.7500 1329.9000
Other 191 253.000000 16629.7000 0.0000
---------------------------------------------------------
Total 4237 5091.500000 182255.5700 106046.9200
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 288 8088.750000 16959.1200 16912.8400
10 181.000000 339.7600 0.0000
Other 2941 5405.750000 75727.5400 0.0000
---------------------------------------------------------
Total 3239 13675.500000 93026.4200 16912.8400
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 6.000000 223.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 332 438.500000 17625.5000 0.0000
P 328 600.750000 28431.1900 28321.1900
D 5 7.250000 297.1500 0.0000
S 0 0.000000 0.0000 0.0000
H 13 34.500000 1387.5300 1387.5300
T 0 0.000000 0.0000 0.0000
1307 1516.500000 65281.3500 0.0000
Other 25 33.750000 1291.9000 0.0000
---------------------------------------------------------
Total 2014 2637.250000 114537.8200 29708.7200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.000000 596.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 441 674.250000 28523.9500 0.0000
P 530 832.750000 37627.5000 40339.7100
D 36 49.750000 1985.2000 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
1521 1815.000000 89280.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2535 3381.750000 158013.1900 40339.7100
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 8.500000 316.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 969 863.500000 32073.7000 25913.3600
P 733 5070.250000 42419.5600 42419.5600
D 3 1.750000 64.9500 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
1912 1412.750000 48261.0400 858.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3624 7356.750000 123135.4500 69191.7100
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 104 109.750000 2468.2900 2468.2900
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
3427 3537.000000 159834.5100 0.0000
Other 21 15.500000 575.9000 0.0000
---------------------------------------------------------
Total 3552 3662.250000 162878.7000 2468.2900
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.500000 93.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 134 152.750000 7216.2000 0.0000
P 838 1044.316800 48587.0400 48577.7300
D 9 13.500000 880.2000 0.0000
S 0 0.000000 0.0000 0.0000
H 18 36.000000 2700.0000 0.0000
T 0 0.000000 0.0000 0.0000
1818 1280.183200 50260.2125 0.0000
Other 74 48.000000 1970.8000 0.0000
---------------------------------------------------------
Total 2895 2577.250000 111707.4525 48577.7300
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 13.250000 492.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 320 489.250000 23088.1000 166.8000
P 1956 2674.250000 123762.4000 123648.1400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 538 680.500000 38083.8500 0.0000
T 198 258.750000 12302.7000 12302.7000
166 298.500000 19732.3500 0.0000
Other 169 316.500000 22304.2500 0.0000
---------------------------------------------------------
Total 3357 4731.000000 239766.5500 136117.6400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 7.000000 260.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 2138 2488.000000 114628.9500 0.0000
P 20 30.500000 1718.0500 0.0000
D 39 67.750000 4673.7000 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
2014 2762.000000 135406.2500 0.0000
Other 7 8.000000 297.6000 0.0000
---------------------------------------------------------
Total 4235 5363.250000 256984.9500 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 4 5.500000 334.5000 0.0000
P 90 91.500000 4109.4600 4109.4600
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
20 26.500000 1548.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 114 123.500000 5992.7100 4109.4600
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.250000 233.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 113 153.250000 7747.3000 74.4000
P 506 723.750000 37484.2500 36138.5500
D 56 112.750000 6716.0500 110.0000
S 61 55.500000 2438.1500 204.9000
H 41 81.500000 5888.2500 0.0000
T 230 2010.500000 13620.3900 12409.9900
650 682.250000 29196.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1659 3823.750000 103324.4900 48937.8400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 7.500000 562.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 153 168.500000 8276.4000 0.0000
P 1261 1320.250000 61180.0500 61169.0500
D 92 106.250000 6019.7500 0.0000
S 39 27.000000 1310.2500 0.0000
H 11 17.000000 1275.0000 0.0000
T 75 634.000000 1812.0500 1812.0500
2127 1687.000000 63641.1300 0.0000
Other 66 46.500000 1822.6500 0.0000
---------------------------------------------------------
Total 3829 4014.000000 145899.7800 62981.1000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 235 305.250000 14897.0600 0.0000
P 2168 2566.250000 114275.8200 113868.1400
D 52 53.000000 2648.2500 0.0000
S 2 3.250000 124.1000 0.0000
H 18 32.000000 2400.0000 0.0000
T 193 792.000000 12926.5300 12926.5300
2355 2829.500000 111232.4800 0.0000
Other 21 20.750000 1112.0000 82.5000
---------------------------------------------------------
Total 5044 6602.000000 259616.2400 126877.1700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 327 574.953067 29186.2800 0.0000
P 1061 1830.086933 97551.0700 97348.0700
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 42 84.000000 6250.0000 0.0000
T 0 0.000000 0.0000 0.0000
3962 3692.126662 166798.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5393 6182.499995 299886.3000 97348.0700
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 11.750000 511.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 548 992.500000 46308.6000 0.0000
P 1008 1956.500000 88431.7500 89103.1700
D 57 95.500000 6265.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 32 53.250000 3553.9500 2363.1500
2148 3240.750000 143144.1900 525.0000
Other 3 3.000000 30.0000 30.0000
---------------------------------------------------------
Total 3802 6353.250000 288245.4900 92021.3200