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:GR
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 2950 14211.25000 527958.2500 37.1507
Subtotal (Total Children Is Unduplicated) 4506 19189.75000 694315.8500 36.1816
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Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 18 58.691400 2934.5700 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 16 31.166667 2337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 16 26.500000 1987.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 5 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 19.000000 1425.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.000000 825.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 17.000000 1275.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 8.500000 637.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 61.000000 3385.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 27 47.000000 2608.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 238 400.287331 29416.1800 73.4877
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 327 545.333333 40761.0000 74.7451
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 70 125.094933 9232.1200 73.8009
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 178 313.000000 23437.5000 74.8802
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 95.741400 7180.6050 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 159 266.000000 19950.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 450 798.500000 44289.0000 55.4652
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 594 1022.500000 56737.7500 55.4892
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 134 204.934100 15370.0575 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 116 200.000000 14972.3000 74.8615
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 18 18.000000 1319.4600 73.3033
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
Subtotal (Total Children Is Unduplicated) 1511 4297.249164 281807.0425 65.5785
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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 2 16.000000 800.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 16.000000 800.0000 50.0000
INTR-T1013-INTERPRETER 147 357.750000 17211.0000 48.1090
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 431 914.000000 9146.0000 10.0066
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 487 20402.00000 9045.9200 0.4434
Subtotal (Total Children Is Unduplicated) 912 21947.99970 38727.3800 1.7645
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Total 45434.998864 1014850.2725 22.3363
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Number of Children (Unduplicated) With at Least One Service 4822
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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 293 1239.750000 11972.8500 11972.8500
D 7 89.250000 110.3500 0.0000
S 4 3.500000 129.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 42 215.000000 2306.8600 2306.8600
1352 1024.250000 39816.6500 585.9000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 1699 2572.000000 54345.7600 14865.6100
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 268 8053.250000 14296.6200 14250.3400
9 179.000000 189.7600 0.0000
Other 1960 4555.000000 37394.4900 0.0000
---------------------------------------------------------
Total 2237 12787.250000 51880.8700 14250.3400
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 132 318.000000 13210.3300 13210.3300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 7 23.500000 660.0300 660.0300
T 0 0.000000 0.0000 0.0000
1162 1307.000000 54384.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1301 1648.500000 68254.9100 13870.3600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.750000 27.7500 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
1233 1515.500000 65972.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1234 1516.250000 66000.1100 0.0000
Center 05
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 730 5065.750000 42082.0600 42082.0600
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
1912 1412.750000 48261.0400 858.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2642 6478.500000 90343.1000 42940.8500
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 92 91.750000 1383.7500 1383.7500
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
1528 1199.500000 46138.5000 0.0000
Other 21 15.500000 575.9000 0.0000
---------------------------------------------------------
Total 1641 1306.750000 48098.1500 1383.7500
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 200 252.000000 7583.3300 7583.3300
D 2 4.000000 300.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
1802 1254.683200 48404.4125 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2005 1512.683200 56437.7425 7583.3300
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 1525 1968.250000 87009.5500 87009.5500
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 174 211.750000 8962.9500 8962.9500
10 14.250000 530.1000 0.0000
Other 21 40.500000 2998.5000 0.0000
---------------------------------------------------------
Total 1730 2234.750000 99501.1000 95972.5000
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 1 2.000000 111.0000 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
1559 1974.250000 83352.8500 0.0000
Other 2 2.250000 83.7000 0.0000
---------------------------------------------------------
Total 1562 1978.500000 83547.5500 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 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
2 1.500000 93.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 92 93.000000 4202.4600 4109.4600
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 2.000000 111.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 5 11.250000 603.2500 0.0000
S 1 2.000000 74.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 134 1820.000000 1546.7900 1217.1900
567 534.250000 19336.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 708 2369.500000 21671.2900 1217.1900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 37.2000 0.0000
P 0 0.000000 0.0000 0.0000
D 41 32.000000 1422.8000 0.0000
S 33 18.750000 757.6500 0.0000
H 0 0.000000 0.0000 0.0000
T 65 615.500000 726.8000 726.8000
1945 1414.250000 46866.1800 0.0000
Other 2 2.500000 149.7000 0.0000
---------------------------------------------------------
Total 2087 2084.000000 49960.3300 726.8000
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 0 0.000000 0.0000 0.0000
D 33 24.000000 891.4500 0.0000
S 1 0.250000 12.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 146 707.000000 7799.5300 7799.5300
2024 2232.500000 72580.4800 0.0000
Other 5 2.750000 102.2000 0.0000
---------------------------------------------------------
Total 2209 2966.500000 81386.1600 7799.5300
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 86 159.836933 10034.7700 10034.7700
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
3584 3000.728731 119256.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3670 3160.565664 129291.1400 10034.7700
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.500000 262.5000 262.5000
1839 2722.750000 109667.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1841 2726.250000 109929.6000 262.5000