CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 1
List order: No List
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 11039 14502.50000 536207.2500 36.9734
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 323 267.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6715 22169.75000 819439.7500 36.9621
Subtotal (Total Children Is Unduplicated) 14484 36939.75000 1355647.0000 36.6989
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 21.000000 970.0000 46.1905
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.4200 19.7100
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 3 3.000000 41.6100 13.8700
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 2 2.000000 18.1600 9.0800
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 2 2.000000 55.6600 27.8300
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 44.8000 22.4000
EVAL-96111-DEVELOPMENTAL EVALUATION 75 87.500000 4375.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 4.000000 200.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 326 567.500000 28375.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 7 9.000000 675.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 18.500000 1387.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 5 8.500000 637.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 4 7.000000 525.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 13.500000 1012.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 55.500000 3080.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 50 86.500000 4800.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 48 81.271467 5910.3600 72.7237
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 259 441.939466 32880.0000 74.3993
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 28 49.000000 3675.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 142 244.038400 18302.8800 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 14 24.500000 1837.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 113 212.000000 15825.0000 74.6462
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 126 230.500000 12792.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 540 933.819820 51827.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 38 69.500000 5212.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 139 231.500000 17362.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 48 49.000000 2886.5900 58.9100
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 4 4.000000 93.6800 23.4200
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 1.539275 78.5800 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 3 3.000000 105.0900 35.0300
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 599.8400 49.9867
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 3.000000 150.0000 50.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 127.8900 42.6300
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 2 4.000000 201.0500 50.2625
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 31 31.000000 1582.5500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 1528 3596.608428 221994.0500 61.7232
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 22.000000 2091.5200 95.0691
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 463 531.250000 26500.0000 49.8824
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 766 875.250000 43762.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 281 294.500000 7362.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 469 572.500000 28593.7500 49.9454
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1103 1317.250000 65789.0000 49.9442
CONIP-CONIP-CONSULT, ITDS PHONE 137 131.250000 3231.2500 24.6190
CONOF-CONOF-CONSULT, OT, FACE TO FACE 305 391.750000 19587.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 712 620.750000 29825.0000 48.0467
CONOP-CONOP-CONSULT, OT, PHONE 56 129.500000 3187.5000 24.6139
CONPF-CONPF-CONSULT, PT, FACE TO FACE 147 169.500000 8475.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 456 352.000000 17575.0000 49.9290
CONPP-CONPP-CONSULT, PT, PHONE 19 13.000000 325.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 402 421.750000 21087.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 806 808.500000 40425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 99 93.250000 2331.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 190 262.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1498 8300.000000 414200.0000 49.9036
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 918 4578.500000 228800.0000 49.9727
INTR-T1013-INTERPRETER 181 796.250000 40715.0000 51.1334
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7269 53619.00000 535660.0100 9.9901
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 Page: 2
List order: No List
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
OCCT-97530-OT SESSION BY LICENSED OT 172 780.324045 53545.9200 68.6201
OCCT-97530GT-OT SESSION BY LICENSED OT 54 169.750000 12017.3900 70.7946
OCCT-97530HM-OT SESSION BY OT ASST 29 127.011711 7079.1100 55.7359
OCCT-97530HMGT-OT SESSION BY OT ASST 10 40.065910 2291.7700 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 108 507.193165 35339.1200 69.6759
PHY-97110GT-PT SESSION BY LICENSED PT 50 213.500000 15234.5800 71.3563
PHY-97110HM-PT SESSION BY PT ASST 9 51.361092 2935.8000 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 9.739678 556.7200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 420 2163.776600 150470.8300 69.5408
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 181 780.428606 55191.4900 70.7195
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.750000 39.1700 52.2267
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 357.2000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 57.500000 638.4800 11.1040
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 282 430.000000 15900.7200 36.9784
TRAV-TRAVS-Travel by mile 2189 178358.0000 78523.5100 0.4403
Subtotal (Total Children Is Unduplicated) 10860 258005.4008 1970013.9700 7.6356
-----------------------------------------------------------------------------------------------------------------------
Total 298541.759235 3547655.0200 11.8833
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 18764
-----------------------------------------------------------------------------------------------------------------------
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 6732 31117.500000 111098.9700 111098.9700
D 604 3647.500000 10077.2900 0.0000
S 22 6.250000 231.2500 0.0000
H 1 0.250000 9.2500 0.0000
T 2917 10253.000000 47197.2900 47197.2900
4785 2909.000000 116812.8100 0.0000
Other 77 27.000000 999.0000 0.0000
---------------------------------------------------------
Total 15138 47960.500000 286425.8600 158296.2600
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 2348 7282.000000 60805.5700 60534.7900
292 280.500000 6889.8000 0.0000
Other 2318 1142.250000 45605.8900 0.0000
---------------------------------------------------------
Total 4958 8704.750000 113301.2600 60534.7900
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 1970 16525.750000 51198.2300 51198.2300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 124 1173.250000 2356.1300 2356.1300
T 0 0.000000 0.0000 0.0000
4872 6915.750000 121005.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6966 24614.750000 174559.8800 53554.3600
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 1898 7036.500000 119704.9300 119704.9300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 45.000000 880.0800 870.0800
T 0 0.000000 0.0000 0.0000
2951 2936.500000 119997.0200 0.0000
Other 5 26.000000 860.0000 800.0000
---------------------------------------------------------
Total 4868 10044.000000 241442.0300 121375.0100
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 4039 22676.250000 137486.1400 137486.1400
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
2192 1649.500000 52131.9200 5073.4200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6231 24325.750000 189618.0600 142559.5600
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 6735 6708.500000 144178.2500 144178.2500
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
8158 5156.000000 160016.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14893 11864.500000 304194.9700 144178.2500
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 3326 10849.500000 178606.5200 178606.5200
D 17 16.500000 838.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 11.500000 805.5000 0.0000
T 0 0.000000 0.0000 0.0000
7114 3764.000000 137755.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10463 14641.500000 318006.2700 178606.5200
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 7762 42961.000000 396600.1500 396600.1500
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 3753 19520.000000 175075.6600 175084.9100
30 25.250000 960.2500 0.0000
Other 8 16.000000 1200.0000 0.0000
---------------------------------------------------------
Total 11553 62522.250000 573836.0600 571685.0600
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 3854 11633.750000 288094.4200 288094.4200
D 1 0.500000 18.5000 0.0000
S 36 48.000000 1306.8300 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3771 2977.500000 112833.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7662 14659.750000 402252.7500 288094.4200
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 1045 6667.000000 77499.7300 77492.4200
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 18.000000 405.3700 405.3700
T 0 0.000000 0.0000 0.0000
397 284.250000 12196.5000 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1448 6969.250000 90101.6000 77917.7900
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 1 2.000000 111.0000 52.2800
D 9 12.500000 662.5000 0.0000
S 156 140.250000 5115.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 3449 39786.500000 81009.0400 79619.1600
1994 1289.250000 42533.3700 86.8700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5609 41230.500000 129431.1600 79758.3100
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 0 0.000000 0.0000 0.0000
D 13 8.750000 392.6300 0.0000
S 7 2.500000 125.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 143 130.000000 6254.7600 4606.7600
5240 2967.750000 118066.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5403 3109.000000 124839.3700 4606.7600
Center 54
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 50.0000 0.0000
P 1 1.000000 50.0000 50.0000
D 4 2.500000 161.3800 0.0000
S 1 1.000000 24.8300 0.0000
H 0 0.000000 0.0000 0.0000
T 431 432.500000 20288.6700 20288.6700
6399 4006.000000 172637.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6837 4444.000000 193212.1300 20338.6700
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 5288 7827.446282 89067.6400 89067.6400
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
4722 3502.312953 92898.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10010 11329.759235 181965.7000 89067.6400
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 3 4.000000 40.0000 40.0000
H 0 0.000000 0.0000 0.0000
T 2361 9138.750000 112529.4900 112519.4900
3302 2978.750000 111898.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5666 12121.500000 224467.9200 112559.4900