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:TPIN
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 8 7.250000 269.7000 37.2000
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 1 0.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 63 171.358872 6367.9500 37.1615
Subtotal (Total Children Is Unduplicated) 68 179.108872 6637.6500 37.0593
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
EVAL-96111-DEVELOPMENTAL EVALUATION 5 6.000000 300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 9 12.852600 642.6300 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 39 81.833333 5523.0200 67.4911
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 46 87.000000 6455.6800 74.2032
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 17 32.000000 2400.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 27 54.000000 4050.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 13 21.500000 1612.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 14 30.000000 2250.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 24 43.000000 3225.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 15 25.500000 1893.0000 74.2353
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 38 73.000000 4051.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 58 111.500000 6139.1100 55.0593
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 752 1484.688431 107760.1325 72.5810
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 888 1686.123766 125747.4525 74.5778
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 216 409.329866 30699.7400 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 527 1110.500000 82727.4000 74.4956
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 256 481.761700 35962.1275 74.6471
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 352 747.745100 55342.9425 74.0131
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 583 1122.643782 62173.7300 55.3815
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1311 2495.000000 137627.2500 55.1612
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 493 872.596400 65444.7300 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 298 496.079700 37064.2225 74.7142
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 77 78.000000 23712.0000 304.0000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 224.4700 112.2350
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 30 31.000000 1504.0000 48.5161
SPCH-92521-EVAL OF SPEECH FLUENCY 5 5.000000 257.0500 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 30 36.000000 1738.0500 48.2792
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 154.2300 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 15 83.000000 3920.5300 47.2353
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 1 8.000000 421.9200 52.7400
Subtotal (Total Children Is Unduplicated) 3651 11739.65468 811482.8775 69.1232
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 24 58.000000 4165.8800 71.8255
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 9 9.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 11 12.500000 587.5000 47.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 301 2907.000000 141406.2500 48.6434
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 78 310.250000 15512.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1 2.000000 20.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 105 859.090000 62655.2800 72.9321
OCCT-97530GT-OT SESSION BY LICENSED OT 62 205.120000 15168.1100 73.9475
OCCT-97530HM-OT SESSION BY OT ASST 2 16.000000 507.7200 31.7325
OCCT-97530TL-OT SESSION BY LICENSED OT 4 10.000000 719.6000 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 4 11.000000 788.4400 71.6764
PHY-97110-PT SESSION BY LICENSED PT 110 1168.830000 86539.1400 74.0391
PHY-97110GT-PT SESSION BY LICENSED PT 44 93.130000 6687.8200 71.8117
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 248 2401.520471 169189.4500 70.4510
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 90 249.500000 18270.5000 73.2285
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 7 30.000000 2157.7600 71.9253
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 4 25.000000 1795.3600 71.8144
Subtotal (Total Children Is Unduplicated) 791 8371.940471 526437.1900 62.8811
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Total 20290.704021 1344557.7175 66.2647
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Number of Children (Unduplicated) With at Least One Service 4121
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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 0 0.000000 0.0000 0.0000
S 2 3.000000 161.0000 0.0000
H 1265 1513.500000 102772.2600 0.0000
T 0 0.000000 0.0000 0.0000
609 734.000000 48466.3500 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 1877 2252.500000 151549.6100 0.0000
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 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 1 2.000000 111.0000 0.0000
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 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 1.500000 112.5000 112.5000
T 0 0.000000 0.0000 0.0000
70 94.250000 6870.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 71 95.750000 6983.1000 112.5000
Center 04
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 99 113.500000 14237.5000 19834.7400
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
297 348.000000 37701.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 396 461.500000 51938.9700 19834.7400
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 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
2 0.500000 18.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 0.500000 18.6000 0.0000
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
990 1985.750000 134025.6000 0.0000
Other 4 5.250000 307.5000 0.0000
---------------------------------------------------------
Total 994 1991.000000 134333.1000 0.0000
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 42 39.897000 2992.2700 2993.1700
D 28 54.749300 4106.1975 0.0000
S 0 0.000000 0.0000 0.0000
H 100 200.000000 15000.0000 0.0000
T 0 0.000000 0.0000 0.0000
102 189.750000 13719.0000 0.0000
Other 1 2.000000 150.0000 0.0000
---------------------------------------------------------
Total 273 486.396300 35967.4675 2993.1700
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 216 319.000000 17766.1500 18796.9800
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 10 18.500000 1163.2500 1163.2500
177 309.000000 19826.2100 288.0000
Other 2 4.000000 261.0000 0.0000
---------------------------------------------------------
Total 405 650.500000 39016.6100 20248.2300
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 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
1578 3237.000000 220839.0000 0.0000
Other 2 4.000000 251.2500 0.0000
---------------------------------------------------------
Total 1580 3241.000000 221090.2500 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 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
6 8.500000 501.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 8.500000 501.0000 0.0000
Center 52
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 406 562.500000 30604.4500 21993.2600
D 968 1071.500000 57538.3800 535.3000
S 3 6.000000 450.0000 410.0000
H 389 503.000000 32887.5400 0.0000
T 1946 2117.000000 116735.9400 82802.7300
181 219.250000 13113.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3893 4479.250000 251330.1100 105741.2900
Center 53
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 111 95.356440 10920.9900 8497.1700
D 783 806.533560 48695.7400 0.0000
S 5 5.500000 350.0000 0.0000
H 446 476.250000 34247.7500 0.0000
T 0 0.000000 0.0000 0.0000
948 1008.000000 69147.9800 359.8000
Other 55 36.250000 2572.1900 0.0000
---------------------------------------------------------
Total 2348 2427.890000 165934.6500 8856.9700
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 75 64.520000 8117.6700 8054.2900
D 566 597.330000 37382.3200 0.0000
S 0 0.000000 0.0000 0.0000
H 453 501.750000 36064.9300 0.0000
T 0 0.000000 0.0000 0.0000
1108 1219.250000 83778.4200 0.0000
Other 10 9.750000 687.5500 0.0000
---------------------------------------------------------
Total 2212 2392.600000 166030.8900 8054.2900
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 3 3.459733 259.4800 259.4800
D 0 0.000000 0.0000 0.0000
S 1 0.833333 62.5000 0.0000
H 140 213.665509 15509.9900 0.0000
T 0 0.000000 0.0000 0.0000
256 314.500274 22636.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 400 532.458849 38468.4500 259.4800
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 32 59.858872 3932.2500 7918.1900
D 116 216.500000 14355.7500 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
533 992.500000 62995.9100 329.4000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 681 1268.858872 81283.9100 8247.5900