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:EIP DEI DEIP
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 11018 14483.25000 535495.0000 36.9734
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 323 267.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20010 66843.50000 2471296.8000 36.9714
Subtotal (Total Children Is Unduplicated) 21132 81594.25000 3006791.8000 36.8505
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 11 15.000000 679.0000 45.2667
EVAL-96111-DEVELOPMENTAL EVALUATION 70 77.500000 3875.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 78 104.750000 5237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 16 25.500000 1912.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 77 120.500000 9037.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 7.000000 525.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 47 72.500000 5408.2500 74.5966
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 19 30.000000 2250.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 52.500000 3937.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 50 88.000000 6600.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 33.000000 1831.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 118 217.500000 12015.7500 55.2448
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 211 386.000000 28950.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1455 2586.000000 192906.7500 74.5966
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 64 110.500000 8287.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 711 1185.500000 88867.5000 74.9620
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 71 135.000000 10125.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 401 698.000000 52030.0000 74.5415
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 321 598.000000 33189.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1760 3132.000000 173236.7900 55.3119
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 159 314.500000 23548.5000 74.8760
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 657 1139.500000 85433.2500 74.9743
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 75 76.000000 7663.3300 100.8333
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 7 7.000000 163.9400 23.4200
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 25 25.000000 1250.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 14.000000 714.7000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 357.3500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 2 2.000000 97.8800 48.9400
SPCH-92610GT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 3748 11293.25000 761964.2900 67.4708
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 81.750000 4062.5000 49.6942
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 256 298.500000 14925.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 53 56.000000 1400.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 83 92.250000 4612.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 676 641.750000 32014.0000 49.8855
CONIP-CONIP-CONSULT, ITDS PHONE 18 15.000000 375.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 35 35.750000 1787.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 479 347.250000 16150.0000 46.5083
CONOP-CONOP-CONSULT, OT, PHONE 3 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 45 44.750000 2237.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 314 179.500000 8950.0000 49.8607
CONPP-CONPP-CONSULT, PT, PHONE 6 5.000000 125.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 103 112.500000 5625.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 318 238.750000 11937.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 21 18.750000 468.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 191 265.750000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 1.500000 37.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 211 898.250000 44852.5000 49.9332
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 610 2174.250000 108612.5000 49.9540
INTR-T1013-INTERPRETER 52 123.750000 6187.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 157 747.000000 7452.0000 9.9759
OCCT-97530-OT SESSION BY LICENSED OT 31 75.500000 5393.7200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 120 445.250000 31808.6600 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 4 5.750000 410.7800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 100 427.500000 30540.6000 71.4400
PHY-97110-PT SESSION BY LICENSED PT 57 138.250000 9876.5800 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 93 392.250000 28022.3400 71.4400
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:EIP DEI DEIP
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
PHY-97110TL-PT SESSION BY LICENSED PT 10 15.000000 1071.6000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 63 268.250000 19163.7800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 129 571.000000 39627.4000 69.4000
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 200 720.500000 51232.1600 71.1064
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 45 244.250000 17449.2200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 118 565.500000 40399.3200 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 8.750000 121.4500 13.8800
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 139 168.500000 6225.2500 36.9451
TRAV-TRAVS-Travel by mile 167 9774.000000 4348.8800 0.4449
Subtotal (Total Children Is Unduplicated) 2392 20202.25000 557592.8700 27.6005
-----------------------------------------------------------------------------------------------------------------------
Total 113089.750000 4326348.9600 38.2559
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21383
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8 2.000000 74.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 4 4.750000 175.7500 0.0000
S 3524 2253.500000 101139.4200 0.0000
H 5765 3541.750000 153741.4300 117907.7500
T 1 0.250000 9.2500 0.0000
4922 2978.750000 124937.1900 0.0000
Other 177 64.750000 2471.7500 0.0000
---------------------------------------------------------
Total 14401 8845.750000 382548.7900 117907.7500
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 3441 1970.250000 83050.8900 0.0000
---------------------------------------------------------
Total 3441 1970.250000 83050.8900 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 3529 2563.250000 108901.4200 0.0000
P 47 46.750000 2404.4400 2357.4400
D 53 33.750000 1248.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 3 4.500000 312.5000 312.5000
T 0 0.000000 0.0000 0.0000
4828 3193.250000 147222.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8460 5841.500000 260090.0100 2669.9400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 71 116.250000 4358.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2338 3819.000000 149552.2500 0.0000
P 1000 1657.250000 64481.2500 64452.5000
D 91 149.750000 5925.5000 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
3386 3548.750000 155484.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6886 9291.000000 379801.7700 64452.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2685 1914.750000 73247.6600 12339.5050
P 35 61.250000 3262.2500 3262.2500
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
2056 1275.750000 47128.2500 55.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4779 3253.000000 123684.4100 15656.7550
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
12798 7973.000000 322732.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12798 7973.000000 322732.2500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 14 20.500000 1366.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 696 558.750000 22017.2500 0.0000
P 2898 2393.250000 102532.0000 102406.2000
D 18 18.500000 988.5000 0.0000
S 1 1.000000 50.0000 0.0000
H 40 79.500000 5905.5000 0.0000
T 0 0.000000 0.0000 0.0000
7228 3901.000000 145781.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10895 6972.500000 278641.0000 102406.2000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 10.500000 370.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 769 824.000000 31310.2500 0.0000
P 8792 8580.000000 335776.0100 336187.8700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 177 301.000000 16675.0000 0.0000
T 3059 2784.000000 106384.6800 105739.9300
243 255.000000 11453.5300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13052 12754.500000 501969.4700 441927.8000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 285 206.000000 7980.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1475 1144.500000 44993.5000 0.0000
P 6920 5612.500000 233098.0000 235709.6500
D 76 93.000000 5637.0000 0.0000
S 96 177.000000 12134.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4060 3622.500000 157181.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12912 10855.500000 461024.0000 235709.6500
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 0.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 10 7.750000 532.7500 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
666 543.750000 24284.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 677 553.500000 24818.3700 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.250000 307.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 429 449.750000 23363.8700 0.0000
P 1536 1597.750000 70916.3400 70246.8600
D 99 124.000000 6613.3200 0.0000
S 429 422.000000 17246.7100 155.0500
H 92 108.000000 6963.2300 40.0000
T 1103 10890.000000 36111.7800 29010.1100
2051 1322.000000 47612.7800 11.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5745 14919.750000 209135.2800 99463.5900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 11.750000 469.1900 0.0000
U 0 0.000000 0.0000 0.0000
B 3197 2848.250000 135143.0400 0.0000
P 1255 1208.000000 56348.6400 56038.8900
D 73 67.750000 3716.1700 0.0000
S 14 9.500000 475.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 50 40.000000 1975.5000 0.0000
5720 3509.000000 154655.1600 0.0000
Other 45 41.000000 2658.7600 37.0000
---------------------------------------------------------
Total 10365 7735.250000 355441.4600 56075.8900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 44.750000 1655.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 3781 3433.000000 155643.4900 105.0500
P 1763 1500.250000 67280.6500 67077.1500
D 60 48.750000 3127.7800 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
6585 4230.500000 192981.8600 0.0000
Other 47 48.250000 2994.3700 177.2500
---------------------------------------------------------
Total 12271 9305.500000 423683.9000 67359.4500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2974 2390.500000 101758.3200 0.0000
P 415 313.500000 12641.3000 15808.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 33 54.500000 3979.7300 0.0000
T 0 0.000000 0.0000 0.0000
3923 2094.500000 81295.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7345 4853.000000 199675.1400 15808.3500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 8.750000 323.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 641 728.250000 27939.3100 148.0000
P 3449 3963.000000 161258.1900 160153.5400
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
3519 3265.750000 130530.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7617 7965.750000 320052.2200 160301.5400