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
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 28 19.750000 730.7500 37.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 15 22.750000 841.7500 37.0000
Subtotal (Total Children Is Unduplicated) 43 42.500000 1572.5000 37.0000
-----------------------------------------------------------------------------------------------------------------------
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 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 6 12.000000 600.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 249 464.750000 23237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 4 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 525.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 47.000000 2608.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 11 20.000000 1110.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 29.771467 2047.8600 68.7860
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 97 164.533333 12169.5400 73.9640
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 17 31.000000 2325.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 25 43.538400 3265.3800 75.0000
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 72 136.000000 10200.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 39 73.000000 4051.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 101 195.819820 10868.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 4 6.500000 487.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 32 57.500000 4312.5000 75.0000
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 4 4.000000 204.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 12 12.000000 599.8400 49.9867
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 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
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 29 29.000000 1480.4500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 712 1438.452295 85497.7800 59.4373
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 22.000000 2091.5200 95.0691
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 392 449.500000 22437.5000 49.9166
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 544 576.750000 28837.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 236 238.500000 5962.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 387 480.250000 23981.2500 49.9349
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 443 675.500000 33775.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 119 116.250000 2856.2500 24.5699
CONOF-CONOF-CONSULT, OT, FACE TO FACE 270 356.000000 17800.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 233 273.500000 13675.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 53 126.500000 3112.5000 24.6047
CONPF-CONPF-CONSULT, PT, FACE TO FACE 103 125.750000 6287.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 142 173.500000 8675.0000 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 488 570.250000 28512.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 78 74.500000 1862.5000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 9.000000 225.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1473 8201.000000 409250.0000 49.9025
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 819 4265.500000 213150.0000 49.9707
INTR-T1013-INTERPRETER 129 672.500000 34527.5000 51.3420
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 7178 52872.00000 528208.0100 9.9903
OCCT-97530-OT SESSION BY LICENSED OT 171 777.324045 53331.6000 68.6092
OCCT-97530GT-OT SESSION BY LICENSED OT 35 111.500000 7856.0100 70.4575
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
PHY-97110-PT SESSION BY LICENSED PT 105 503.193165 35053.3600 69.6618
PHY-97110GT-PT SESSION BY LICENSED PT 27 95.500000 6804.6600 71.2530
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 401 2101.276600 146005.8300 69.4843
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 126 546.428606 38474.5300 70.4109
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 0.750000 39.1700 52.2267
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
SPL-92508-GROUP SPL SESSION PER CHILD 3 57.500000 638.4800 11.1040
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 143 261.500000 9675.4700 36.9999
TRAV-TRAVS-Travel by mile 2099 168584.0000 74174.6300 0.4400
Subtotal (Total Children Is Unduplicated) 9668 243863.1508 1785806.6700 7.3230
-----------------------------------------------------------------------------------------------------------------------
Total 245344.103102 1872876.9500 7.6337
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 9930
-----------------------------------------------------------------------------------------------------------------------
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 601 3643.000000 9910.7900 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2917 10253.000000 47197.2900 47197.2900
17 85.500000 1926.3400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10267 45099.000000 170133.3900 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 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2640 7562.500000 67695.3700 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 123 1171.250000 2206.1300 2206.1300
T 0 0.000000 0.0000 0.0000
446 4215.000000 9263.5800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2539 21912.000000 62667.9400 53404.3600
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
65 42.500000 1572.5000 0.0000
Other 5 26.000000 860.0000 800.0000
---------------------------------------------------------
Total 1982 7150.000000 123017.5100 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 4004 22615.000000 134223.8900 134223.8900
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
139 375.500000 5068.4200 5018.4200
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4143 22990.500000 139292.3100 139242.3100
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
1863 1847.000000 35523.2200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8598 8555.500000 179701.4700 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 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 3327 10850.250000 178625.2700 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 1801 37482.750000 188471.1600 188471.1600
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 736 16812.500000 73052.6400 73052.6400
1 2.000000 100.0000 0.0000
Other 8 16.000000 1200.0000 0.0000
---------------------------------------------------------
Total 2546 54313.250000 262823.8000 261523.8000
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 0 0.000000 0.0000 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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3890 11681.750000 289401.2500 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
5 9.000000 434.3200 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1056 6694.000000 78339.4200 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 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 2592 29167.500000 61903.9900 61903.9900
4 42.750000 75.3000 75.3000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2596 29210.250000 61979.2900 61979.2900
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 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 97 96.000000 4606.7600 4606.7600
80 83.500000 4208.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 177 179.500000 8814.7600 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 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 431 432.500000 20288.6700 20288.6700
293 283.750000 13310.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 725 717.250000 33624.2000 20288.6700
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 5286 7825.696282 89002.8900 89002.8900
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
842 1459.906820 15188.5900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6128 9285.603102 104191.4800 89002.8900
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
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2364 9142.750000 112569.4900 112559.4900