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
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
CASE-CASE-NON-TCM CASE MANAGEMENT 1 1.000000 37.2000 37.2000
TCM-T1017TL-TARGETED CASE MANAGEMENT 26679 166611.6183 6186429.4100 37.1308
Subtotal (Total Children Is Unduplicated) 26679 166612.6183 6186466.6100 37.1308
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 91 164.166667 12273.5000 74.7624
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 107 188.500000 14100.0000 74.8011
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 20 36.000000 2700.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 69 118.000000 8850.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 23 43.500000 3262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 46 83.000000 6225.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 44 86.500000 6477.7500 74.8873
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 31 49.500000 3712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 88 157.500000 8713.5000 55.3238
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 188 331.500000 18398.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1708 3075.037467 230484.5600 74.9534
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2306 4100.333333 307023.2500 74.8776
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 490 843.000000 63187.5000 74.9555
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 1275 2189.500000 164128.5000 74.9616
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 526 978.500000 73387.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 761 1361.500000 102083.2500 74.9785
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 2224 3967.500000 220140.7500 55.4860
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 3553 6311.000000 350132.7000 55.4797
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1093 1852.500000 138825.0000 74.9393
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 853 1501.000000 112575.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 19 19.000000 1425.5000 75.0263
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-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 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
SCREEN-T1023-SCREENING 91 92.000000 4600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 3 4.000000 205.6400 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 7 9.000000 462.6900 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 14 85.000000 4491.6900 52.8434
Subtotal (Total Children Is Unduplicated) 9113 27691.03747 1860101.5000 67.1734
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 846 6922.250000 346062.5000 49.9928
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 573 2499.250000 124931.0000 49.9874
OCCT-97530-OT SESSION BY LICENSED OT 52 129.660000 9310.1600 71.8044
OCCT-97530GT-OT SESSION BY LICENSED OT 19 31.880000 2292.0300 71.8955
OCCT-97530HM-OT SESSION BY OT ASST 1 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 173 1272.250000 91306.3900 71.7676
OCCT-97530TLGT-OT SESSION BY LICENSED OT 113 438.250000 31488.1100 71.8497
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 46 210.500000 15123.9400 71.8477
PHY-97110GT-PT SESSION BY LICENSED PT 5 9.000000 645.5600 71.7289
PHY-97110TL-PT SESSION BY LICENSED PT 223 2118.250000 152167.7400 71.8365
PHY-97110TLGT-PT SESSION BY LICENSED PT 85 163.000000 11701.0100 71.7853
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 55 171.200000 12284.0900 71.7529
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 26 40.750000 2929.7700 71.8962
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 255 2095.910000 150497.2300 71.8052
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 120 463.750000 33324.6500 71.8591
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.9200 13.9600
Subtotal (Total Children Is Unduplicated) 1779 16572.90000 984380.1000 59.3970
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Total 210876.555747 9030948.2100 42.8258
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Number of Children (Unduplicated) With at Least One Service 26960
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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 0.250000 9.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 28289 19577.000000 830917.5200 830730.5700
T 1 1.250000 46.5000 0.0000
308 182.500000 6845.1000 6258.9000
Other 326 148.500000 6405.5500 0.0000
---------------------------------------------------------
Total 28925 19909.500000 844223.9700 836989.4700
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 5437 4031.750000 172815.9000 0.0000
---------------------------------------------------------
Total 5437 4031.750000 172815.9000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 103 139.500000 5189.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 5852 3847.500000 148370.7400 0.0000
P 2780 1867.000000 73440.5500 73364.4800
D 77 76.000000 3323.8500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 150.0000
T 0 0.000000 0.0000 0.0000
1770 1324.250000 51673.1800 0.0000
Other 238 225.250000 8621.8000 0.0000
---------------------------------------------------------
Total 10821 7481.500000 290769.5200 73514.4800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 174 297.250000 11590.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 5393 8198.000000 324988.9500 0.0000
P 6234 10227.750000 406264.8000 405521.2300
D 930 1345.250000 51793.4500 0.0000
S 4 5.000000 186.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 3.000000 111.0000 0.0000
825 996.750000 62839.0700 0.0000
Other 2 6.250000 232.5000 0.0000
---------------------------------------------------------
Total 13563 21079.250000 858005.8200 405521.2300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 33 15.000000 558.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 11419 6900.750000 256337.3000 210416.5500
P 0 0.000000 0.0000 0.0000
D 65 32.500000 1203.1500 83.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
13 8.000000 297.6000 0.0000
Other 37 27.500000 1023.0000 0.0000
---------------------------------------------------------
Total 11567 6983.750000 259419.0500 210499.8000
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
21377 16852.000000 707362.4500 0.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 21378 16853.000000 707399.6500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 68.250000 2990.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 1855 1514.000000 68777.4000 0.0000
P 9428 7861.250000 342337.6600 342074.7200
D 158 100.000000 3777.0000 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
32 30.500000 1285.8000 0.0000
Other 143 90.000000 3874.8000 -150.0000
---------------------------------------------------------
Total 11702 9664.000000 423042.7600 341924.7200
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 187.000000 7335.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 8238 8736.500000 352460.2300 5350.7100
P 8287 8849.000000 353642.7100 352456.6300
D 4 6.500000 241.8000 0.0000
S 1 2.000000 102.8200 51.0500
H 0 0.000000 0.0000 0.0000
T 6 3.000000 111.6000 111.0000
6 6.000000 321.9600 0.0000
Other 15 19.250000 804.1000 0.0000
---------------------------------------------------------
Total 16746 17809.250000 715020.8600 357969.3900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 82 73.250000 2893.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 37544 32355.500000 1353898.2000 0.0000
P 185 225.000000 12085.6500 0.0000
D 451 566.750000 34453.6500 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
1797 995.250000 39147.3000 0.0000
Other 520 363.000000 13579.2000 0.0000
---------------------------------------------------------
Total 40579 34578.750000 1456057.8000 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 36 49.500000 3119.2500 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
50 69.000000 3858.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 86 118.500000 6978.0000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 1857 1867.500000 101343.0200 55.8000
P 6648 6902.750000 321345.8600 441322.5300
D 40 58.750000 3645.7500 287.9000
S 515 452.750000 19714.0500 1758.4000
H 13 13.000000 847.6400 0.0000
T 1 1.000000 71.9600 0.0000
95 85.250000 3256.3000 0.0000
Other 1 2.000000 150.0000 150.0000
---------------------------------------------------------
Total 9181 9391.750000 450826.5000 443574.6300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 181 181.000000 12678.3100 0.0000
U 0 0.000000 0.0000 0.0000
B 1258 1128.750000 56195.6600 0.0000
P 11131 10232.710000 512563.3000 512374.5100
D 40 40.000000 2349.1900 0.0000
S 168 171.750000 8713.4000 0.0000
H 17 18.400000 994.0800 0.0000
T 0 0.000000 0.0000 0.0000
40 29.750000 1191.0000 0.0000
Other 551 469.000000 23171.2300 145.8900
---------------------------------------------------------
Total 13386 12271.360000 617856.1700 512520.4000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.000000 520.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2268 2096.000000 99920.9600 0.0000
P 18771 16798.930000 776716.0300 776235.4500
D 88 91.000000 5521.6900 0.0000
S 32 28.860000 1772.6700 37.2000
H 18 18.560000 1265.7200 0.0000
T 0 0.000000 0.0000 0.0000
2 2.250000 83.7000 0.0000
Other 361 320.190000 17058.7800 1550.8300
---------------------------------------------------------
Total 21552 19369.790000 902860.3500 777823.4800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3497 3293.750000 148008.8000 0.0000
P 9370 8679.456933 358519.8700 358188.2600
D 1 0.250000 9.3000 0.0000
S 9 12.080534 830.0400 37.5000
H 1 0.500000 18.6000 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 12879 11986.287467 507395.9100 358235.0600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 32.750000 1442.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 4237 5957.250000 257162.3000 139.5000
P 8905 12752.618280 534773.3500 534808.2160
D 5 8.750000 324.3500 92.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 145 222.500000 10665.9000 7674.2000
0 0.000000 0.0000 0.0000
Other 408 374.250000 13907.3500 0.0000
---------------------------------------------------------
Total 13719 19348.118280 818275.9500 542714.4160