CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/21/2020 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
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 29845 59316.50000 2193982.5000 36.9877
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 17364 20370.75000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 16402 101225.0000 3743195.7500 36.9790
Subtotal (Total Children Is Unduplicated) 38714 180912.2500 5937178.2500 32.8180
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 45 56.000000 2716.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 266 305.500000 15275.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 1973 2795.250000 139750.0000 49.9955
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 71 112.470133 8435.2600 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 11 18.000000 1350.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 32 45.000000 3337.5000 74.1667
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 10 15.500000 1162.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.500000 1368.0000 73.9459
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 5 8.000000 600.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 53 76.000000 5700.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 6 10.000000 750.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 113 149.000000 8269.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 57.000000 3163.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 940 1549.339398 116162.9549 74.9758
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 135 247.003467 18525.2600 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 405 596.000000 44700.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 80 125.500000 9412.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 266 420.000000 31500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 72.000000 5400.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1612 2227.000000 123598.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 272 459.000000 25474.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 467 715.479067 53660.9275 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 172.500000 12937.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 20 20.000000 1178.2000 58.9100
MED-99204-OUTPATIENT VISIT, NEW, 45 MINS 2 2.000000 166.5800 83.2900
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 23.4200
MED-99214-OUTPATIENT VISIT, EST, 25 MINS 1 1.000000 36.4900 36.4900
OCTH-97165-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 9 9.000000 459.4500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 2 3.000000 153.1500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 223 246.000000 12300.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 46 48.118511 2456.4500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 5452 10603.16058 651100.5524 61.4063
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 810 1054.000000 52646.4400 49.9492
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 258 315.250000 15762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 190 177.500000 4437.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1820 2232.500000 111512.5000 49.9496
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 884 899.750000 44975.0000 49.9861
CONIP-CONIP-CONSULT, ITDS PHONE 157 142.750000 3568.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1309 1068.250000 53400.0000 49.9883
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 654 433.250000 21662.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 124 67.750000 1687.5000 24.9077
CONPF-CONPF-CONSULT, PT, FACE TO FACE 966 878.000000 43887.5000 49.9858
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 384 258.000000 12900.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 106 47.500000 1181.2500 24.8684
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1249 1443.750000 72100.0000 49.9394
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 646 621.750000 31075.0000 49.9799
CONSP-CONSP-CONSULT, SLP, PHONE 155 131.750000 3293.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 3981 14247.75000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 43.000000 1075.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 323 2245.000000 112250.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 87 424.250000 21212.5000 50.0000
INTR-T1013-INTERPRETER 790 1747.000000 87267.7500 49.9529
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2919 22171.00000 221660.0000 9.9977
OCCT-97530-OT SESSION BY LICENSED OT 67 440.500000 31412.3600 71.3107
OCCT-97530GT-OT SESSION BY LICENSED OT 28 113.000000 8072.7200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 3 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 46 475.000000 33934.0000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 23 142.500000 10180.2000 71.4400
SENS-HA_INS-SENSORY AID INSURANCE PER EAR 1 1.000000 525.0000 525.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 142 1012.650000 72072.2900 71.1720
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 46 204.750000 14592.1200 71.2680
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 06/30/2020 Date of Report:07/21/2020 Page: 2
List order: No List
Agency Filter:EIP DEI DEIP
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 8 14.000000 194.3200 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 320 546.000000 20202.0000 37.0000
TRAV-TRAVS-Travel by mile 1207 107667.0000 47901.9900 0.4449
Subtotal (Total Children Is Unduplicated) 6908 161271.1500 1156942.6800 7.1739
-----------------------------------------------------------------------------------------------------------------------
Total 352786.560576 7745221.4824 21.9544
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 39643
-----------------------------------------------------------------------------------------------------------------------
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 20 19.750000 1166.8400 0.0000
S 49 34.500000 1408.9000 0.0000
H 2 3.000000 171.4400 0.0000
T 0 0.000000 0.0000 0.0000
27780 17585.750000 619153.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 27851 17643.000000 621901.0100 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 14758 47003.750000 251479.9400 0.0000
---------------------------------------------------------
Total 14758 47003.750000 251479.9400 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 2 2.000000 60.0000 60.0000
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
20913 16232.250000 478055.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20915 16234.250000 478115.3700 60.0000
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 2 2.000000 74.0000 37.0000
D 37 51.750000 2009.2500 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
14597 13095.500000 516273.8000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14637 13149.750000 518375.5500 37.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 1.000000 37.0000 0.0000
P 281 1362.000000 20447.1000 20447.1000
D 115 69.750000 2713.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 1 0.500000 25.0000 25.0000
T 0 0.000000 0.0000 0.0000
11425 6675.250000 205456.2000 205.9500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11825 8108.500000 228679.0500 20678.0500
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 1 0.750000 27.7500 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
26876 14364.250000 491774.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26877 14365.000000 491802.6700 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 2 0.500000 18.5000 46.2500
D 391 270.250000 10940.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 21 42.000000 3150.0000 0.0000
T 0 0.000000 0.0000 0.0000
29351 16345.997800 517608.7325 0.0000
Other 1 2.000000 111.0000 0.0000
---------------------------------------------------------
Total 29766 16660.747800 531828.4825 46.2500
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 39654 33910.500000 1199990.4200 1199990.4200
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
3658 3155.000000 119224.6300 9.2500
Other 2 2.500000 162.5000 0.0000
---------------------------------------------------------
Total 43314 37068.000000 1319377.5500 1199999.6700
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 6.750000 249.7500 0.0000
P 15 35.500000 951.0000 1113.0000
D 76 68.000000 3063.0000 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
23040 16915.750000 544731.5000 0.0000
Other 416 736.000000 49447.5000 0.0000
---------------------------------------------------------
Total 23556 17762.000000 598442.7500 1113.0000
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 1 0.750000 27.7500 0.0000
D 1 0.250000 9.2500 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
10149 7109.000000 244352.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10151 7110.000000 244389.7900 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 4 48.250000 40.1600 40.1600
D 0 0.000000 0.0000 0.0000
S 225 176.750000 5790.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 5785 67559.000000 135547.7000 118708.5300
7083 4798.500000 149925.1600 104.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13097 72582.500000 291303.5200 118853.6000
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 0.500000 18.5000 0.0000
P 4 2.250000 46.2500 27.7500
D 182 187.750000 8011.3300 0.0000
S 3 3.000000 37.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 9 17.500000 451.9500 4.4500
39566 28764.500000 583220.6300 37.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 39765 28975.500000 591785.6600 69.2000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 5.000000 219.4400 0.0000
P 3 0.750000 27.7500 27.7500
D 101 95.400000 5840.8200 0.0000
S 2 2.000000 10.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 21 18.500000 782.6300 0.0000
45058 31201.250000 675833.0300 46.2500
Other 2 2.000000 142.8800 0.0000
---------------------------------------------------------
Total 45195 31324.900000 682856.5500 74.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 9.2500 0.0000
P 6 2.250000 83.2500 100.4700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 3.250000 209.2500 0.0000
T 0 0.000000 0.0000 0.0000
19429 11375.162776 411157.3399 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19440 11381.162776 411459.0899 100.4700
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 8 2.250000 83.2500 83.2500
D 13 10.000000 370.0000 314.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
15283 13405.250000 482971.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15304 13417.500000 483424.5000 397.7500