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
Agency Filter:EXT
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 28 19.750000 730.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 73 94.000000 3441.0000 36.6064
Subtotal (Total Children Is Unduplicated) 90 113.750000 4171.7500 36.6747
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 10 10.000000 195.4000 19.5400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 11 11.000000 156.1200 14.1927
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 23.7000 23.7000
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 10 10.000000 94.3500 9.4350
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 10 11.000000 320.7900 29.1627
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 8 8.000000 173.1600 21.6450
EVAL-96111-DEVELOPMENTAL EVALUATION 7 14.000000 700.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 253 471.250000 23562.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 13 21.500000 1612.5000 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 8 16.000000 1200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.500000 112.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 11 20.000000 1461.0000 73.0500
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 36 58.500000 3246.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 28 55.000000 3052.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 31 60.000001 4315.0000 71.9167
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 232 412.500000 30767.0400 74.5868
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 25 44.000000 3300.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 206 400.500000 29587.5000 73.8764
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 5 9.000000 675.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 167 320.999999 24075.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 73 137.000000 7603.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 370 746.500000 41430.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 9 14.000000 1050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 117 209.500000 15712.5000 75.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 8 33.000000 1650.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 11 11.000000 561.5500 51.0500
OCTF-97168GT-OT RE-EVAL EST PLAN CARE 6 6.000000 306.3000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 17 17.000000 819.7900 48.2229
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 8 8.000000 408.4000 51.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 7 7.000000 357.3500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 75 75.000000 3815.9900 50.8799
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 14 14.000000 714.7000 51.0500
OCTH-97167TL-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 5 5.000000 255.2500 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 6 8.000000 405.2500 50.6563
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 33 33.000000 1659.3900 50.2845
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 8 10.000000 507.3500 50.7350
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 18 18.000000 900.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92521GT-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92522-EVAL OF SPCH SOUND PROD 3 3.000000 153.1500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 93 94.000000 4714.8500 50.1580
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 26 26.000000 1327.3000 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 24 24.000000 1225.2000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 5.000000 204.2000 40.8400
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 1749 3516.250000 217814.7200 61.9452
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 22 44.000000 11389.8100 258.8593
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 2 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 399 457.500000 22837.5000 49.9180
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 550 589.250000 29462.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 256 265.500000 6637.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 389 482.250000 24081.2500 49.9352
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 443 677.500000 33875.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 119 116.250000 2856.2500 24.5699
CONOF-CONOF-CONSULT, OT, FACE TO FACE 275 365.000000 18250.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 234 275.500000 13775.0000 50.0000
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
Agency Filter:EXT
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
CONOP-CONOP-CONSULT, OT, PHONE 53 126.500000 3112.5000 24.6047
CONPF-CONPF-CONSULT, PT, FACE TO FACE 106 129.750000 6487.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 143 174.500000 8725.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 13 8.000000 200.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 299 309.250000 15462.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 489 571.250000 28562.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 78 75.500000 1887.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 14 230.000000 5750.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5005 33696.00000 1683851.0000 49.9718
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2720 14507.50000 725205.0000 49.9883
INTR-T1013-INTERPRETER 131 676.000000 34702.5000 51.3351
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7178 52893.00000 528418.0100 9.9903
OCCT-97530-OT SESSION BY LICENSED OT 816 3822.750000 265955.9100 69.5719
OCCT-97530GT-OT SESSION BY LICENSED OT 177 701.000000 49471.2200 70.5724
OCCT-97530HM-OT SESSION BY OT ASST 248 1432.750000 81082.6600 56.5923
OCCT-97530HMGT-OT SESSION BY OT ASST 47 225.750000 12912.9000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 49 245.750000 17556.3800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 16 35.000000 2500.4000 71.4400
OCCT-97530TLGTHM-OT SESSION BY OT ASST 5 15.500000 886.6000 57.2000
OCCT-97530TLHM-OT SESSION BY OT ASST 8 16.500000 943.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 817 4371.999995 305578.2300 69.8944
PHY-97110GT-PT SESSION BY LICENSED PT 226 762.250000 53241.4000 69.8477
PHY-97110HM-PT SESSION BY PT ASST 93 516.250000 29508.8500 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 18 59.750000 3415.3100 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 35 183.000000 13073.5200 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 12.000000 857.2800 71.4400
PHY-97110TLGTHM-PT SESSION BY PT ASST 3 14.000000 800.2400 57.1600
PHY-97110TLHM-PT SESSION BY PT ASST 7 33.000000 1886.2800 57.1600
SENS-V5264-EARMOLD 5 11.000000 198.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1618 9425.000000 655539.8200 69.5533
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 509 2514.500000 178221.9700 70.8777
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 5 37.000000 2112.6700 57.0992
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 101 440.750000 31487.1800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 7 39.750000 2839.7400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 10 80.500000 923.0200 11.4661
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 143 261.500000 9675.4700 36.9999
TRAV-TRAVS-Travel by mile 2312 199537.0000 87736.6700 0.4397
Subtotal (Total Children Is Unduplicated) 11839 331468.2500 5014148.7400 15.1271
-----------------------------------------------------------------------------------------------------------------------
Total 335098.249995 5236135.2100 15.6257
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 12533
-----------------------------------------------------------------------------------------------------------------------
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 8085 32462.500000 185139.7600 185139.7600
D 785 3827.500000 19675.7900 0.0000
S 1 1.500000 83.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 3520 10853.500000 80744.4600 79478.1300
17 85.500000 1926.3400 0.0000
Other 137 233.500000 15738.0000 0.0000
---------------------------------------------------------
Total 12545 47464.000000 303307.6000 264617.8900
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 2622 7518.750000 77076.0600 76805.2800
345 313.250000 8924.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2967 7832.000000 86000.9600 76805.2800
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 2000 16555.250000 52953.9900 52953.9900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 123 1171.250000 2206.1300 2206.1300
T 0 0.000000 0.0000 0.0000
448 4217.000000 9406.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2571 21943.500000 64566.5800 55160.1200
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 12.000000 444.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 59 48.750000 1766.7500 0.0000
P 1991 7241.000000 132803.1900 127854.1400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1615 5884.000000 297373.2700 870.0800
T 0 0.000000 0.0000 0.0000
66 47.500000 1822.5000 0.0000
Other 87 224.500000 14174.7800 1657.2800
---------------------------------------------------------
Total 3830 13457.750000 448384.4900 130381.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.500000 112.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 4131 22848.250000 148607.9800 148607.9800
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 0 0.000000 0.0000 0.0000
149 395.500000 6377.7700 6327.7700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4281 23245.250000 155098.2500 154935.7500
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 7714 7263.750000 180513.3300 180513.3300
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
7321 6658.500000 292755.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15035 13922.250000 473268.9600 180513.3300
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 3536 11427.750000 217231.9700 217083.9700
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
1 0.750000 18.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3537 11428.500000 217250.7200 217083.9700
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 2884 58067.250000 327543.8700 327543.8700
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 1393 30414.000000 148393.2500 148393.2500
1928 6418.500000 366597.9300 0.0000
Other 157 310.000000 21553.5000 0.0000
---------------------------------------------------------
Total 6362 95209.750000 864088.5500 475937.1200
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 5161 14210.250000 454705.6900 454105.9300
D 0 0.000000 0.0000 0.0000
S 57 79.500000 2668.5100 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3810 10945.000000 631304.1400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9028 25234.750000 1088678.3400 454105.9300
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 1240 7262.750000 117381.7200 117374.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 30.000000 1209.0700 1209.0700
T 0 0.000000 0.0000 0.0000
554 1638.250000 100309.8500 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1805 8931.000000 218900.6400 118603.4800
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 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 3033 30102.750000 120326.3400 120326.3400
1106 2329.750000 141281.5900 75.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4139 32432.500000 261607.9300 120401.6400
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 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 113 112.000000 5406.7600 5406.7600
1177 1222.250000 63569.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1290 1334.250000 68975.8900 5406.7600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 1 1.000000 24.8300 0.0000
H 0 0.000000 0.0000 0.0000
T 534 540.250000 25971.4000 25971.4000
2105 2186.750000 110895.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2640 2728.000000 136891.4400 25971.4000
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 5915 8458.914441 130346.4600 130331.4600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
5068 5668.335554 272760.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10984 14129.249995 403256.8200 130331.4600
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 4 5.000000 90.0000 90.0000
H 0 0.000000 0.0000 0.0000
T 2910 10819.000000 198305.6100 198295.6100
1420 4960.000000 246648.7700 246648.7700
Other 12 21.500000 813.6600 813.6600
---------------------------------------------------------
Total 4346 15805.500000 445858.0400 445848.0400