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
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
TCM-T1017TL-TARGETED CASE MANAGEMENT 3133 16015.50000 594645.2000 37.1294
Subtotal (Total Children Is Unduplicated) 3133 16015.50000 594645.2000 37.1294
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 82.000000 6150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 37 65.000000 4875.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 9.500000 712.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 27 47.000000 3525.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 21 38.000000 2850.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 15 26.500000 1987.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 13 24.500000 1837.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 17 32.500000 2437.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 34 63.000000 3496.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 73 133.500000 7409.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 539 995.953067 74696.4800 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 705 1166.333333 87406.7500 74.9415
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 126 203.500000 15262.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 380 635.000000 47625.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 188 343.000000 25687.5000 74.8907
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 312 500.000000 37500.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 705 1249.500000 69319.5000 55.4778
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1114 1849.500000 102647.2500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 205 334.500000 24962.5000 74.6263
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 285 500.000000 37500.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 3 3.000000 224.1800 74.7267
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 2525 8302.786400 558163.8200 67.2261
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 102.500000 5125.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 5 24.500000 1225.0000 50.0000
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
Subtotal (Total Children Is Unduplicated) 13 164.750000 9062.7200 55.0089
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Total 24483.036400 1161871.7400 47.4562
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Number of Children (Unduplicated) With at Least One Service 3226
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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 1 1.500000 83.2500 0.0000
S 5 7.500000 465.0000 0.0000
H 2012 1793.500000 80164.0500 80164.0500
T 0 0.000000 0.0000 0.0000
25 21.750000 809.1000 744.0000
Other 180 237.750000 15563.6500 0.0000
---------------------------------------------------------
Total 2223 2062.000000 97085.0500 80908.0500
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 981 850.750000 38333.0500 0.0000
---------------------------------------------------------
Total 981 850.750000 38333.0500 0.0000
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 130 162.750000 7027.0000 6917.0000
D 5 7.250000 297.1500 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
95 124.500000 5029.0500 0.0000
Other 25 33.750000 1291.9000 0.0000
---------------------------------------------------------
Total 591 772.750000 31493.8000 6917.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 10.000000 596.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 440 673.500000 28496.2000 0.0000
P 500 800.750000 34311.5000 33988.0000
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
108 123.500000 8027.6800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1091 1657.500000 73416.9800 33988.0000
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 0 0.000000 0.0000 0.0000
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 979 873.750000 32454.8500 25913.3600
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
1593 1782.500000 84510.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1593 1782.500000 84510.9500 0.0000
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 572 664.250000 31398.7000 31389.4000
D 5 5.500000 280.2000 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
4 1.500000 55.8000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 720 828.500000 39193.9000 31389.4000
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 320 497.500000 22235.8500 22120.2200
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
80 152.500000 11437.5000 0.0000
Other 127 234.500000 16310.2500 0.0000
---------------------------------------------------------
Total 857 1387.000000 73564.6000 22287.0200
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 38 65.750000 4562.7000 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
34 27.250000 1013.6500 0.0000
Other 5 5.750000 213.9000 0.0000
---------------------------------------------------------
Total 2252 2624.250000 122397.6500 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 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
18 25.000000 1455.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 22 30.500000 1790.2500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.250000 233.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 112 151.250000 7636.3000 74.4000
P 469 650.250000 32917.0000 32806.7100
D 2 3.500000 205.8000 0.0000
S 60 53.500000 2364.1500 204.9000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
37 60.500000 3787.2000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 682 923.250000 47144.1500 33086.0100
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 5 7.500000 562.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 152 167.500000 8239.2000 0.0000
P 1261 1320.250000 61180.0500 61169.0500
D 16 24.250000 1538.0000 0.0000
S 6 8.250000 552.6000 0.0000
H 2 3.000000 225.0000 0.0000
T 0 0.000000 0.0000 0.0000
130 191.500000 11117.2500 0.0000
Other 64 44.000000 1672.9500 0.0000
---------------------------------------------------------
Total 1636 1766.250000 85087.5500 61169.0500
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 3 6.000000 450.0000 0.0000
S 1 3.000000 111.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
229 411.000000 25521.0000 0.0000
Other 16 18.000000 1009.8000 82.5000
---------------------------------------------------------
Total 2652 3309.500000 156265.2800 113950.6400
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 919 1558.250000 79155.3000 78952.3000
D 0 0.000000 0.0000 0.0000
S 1 1.333333 100.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
258 503.000000 34437.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1505 2637.536400 142878.6300 78952.3000
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 994 1931.500000 86781.0000 86219.4100
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 23 36.250000 2278.9500 1088.1500
3 5.000000 375.0000 375.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1574 2977.000000 136255.0500 87682.5600