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
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 11018 14482.75000 535476.5000 36.9734
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 323 267.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6707 22147.00000 818598.0000 36.9620
Subtotal (Total Children Is Unduplicated) 14455 36897.25000 1354074.5000 36.6985
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 10 14.000000 630.5000 45.0357
EVAL-96111-DEVELOPMENTAL EVALUATION 69 75.500000 3775.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 1 2.000000 100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 77 102.750000 5137.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 5.000000 375.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 11.000000 825.0000 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 4 5.500000 412.5000 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 6 8.500000 471.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 42 66.500000 3690.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 32 51.500000 3862.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 162 277.406133 20710.4600 74.6575
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 11 18.000000 1350.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 117 200.500000 15037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.500000 1162.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 41 76.000000 5625.0000 74.0132
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 87 157.500000 8741.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 442 738.000000 40959.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 34 63.000000 4725.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 108 174.000000 13050.0000 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
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 6 6.000000 300.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 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) 968 2158.156133 136496.2700 63.2467
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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 44 43.750000 2187.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 314 178.500000 8900.0000 49.8599
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 318 238.250000 11912.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 21 18.750000 468.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 190 262.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 25 99.000000 4950.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 103 313.000000 15650.0000 50.0000
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 1 3.000000 214.3200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 19 58.250000 4161.3800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 2.000000 142.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 3 4.000000 285.7600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 23 118.000000 8429.9200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 62.500000 4465.0000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 55 234.000000 16716.9600 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 357.2000 71.4400
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) 1744 14142.25000 184207.3000 13.0253
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Total 53197.656133 1674778.0700 31.4822
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Number of Children (Unduplicated) With at Least One Service 14994
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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 3 4.500000 166.5000 0.0000
S 22 6.250000 231.2500 0.0000
H 1 0.250000 9.2500 0.0000
T 0 0.000000 0.0000 0.0000
4768 2823.500000 114886.4700 0.0000
Other 77 27.000000 999.0000 0.0000
---------------------------------------------------------
Total 4871 2861.500000 116292.4700 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 2318 1142.250000 45605.8900 0.0000
---------------------------------------------------------
Total 2318 1142.250000 45605.8900 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 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 1 2.000000 150.0000 150.0000
T 0 0.000000 0.0000 0.0000
4426 2700.750000 111741.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4427 2702.750000 111891.9400 150.0000
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 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
2886 2894.000000 118424.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2886 2894.000000 118424.5200 0.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
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
2053 1274.000000 47063.5000 55.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2088 1335.250000 50325.7500 3317.2500
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
6295 3309.000000 124493.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6295 3309.000000 124493.5000 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 0 0.000000 0.0000 0.0000
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
7113 3763.250000 137737.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7136 3791.250000 139381.0000 0.0000
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 5961 5478.250000 208128.9900 208128.9900
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 3017 2707.500000 102023.0200 102032.2700
29 23.250000 860.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9007 8209.000000 311012.2600 310161.2600
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 0 0.000000 0.0000 0.0000
D 1 0.500000 18.5000 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
3771 2977.500000 112833.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3772 2978.000000 112851.5000 0.0000
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 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
392 275.250000 11762.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 392 275.250000 11762.1800 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 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 857 10619.000000 19105.0500 17715.1700
1990 1246.500000 42458.0700 11.5700
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3013 12020.250000 67451.8700 17779.0200
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 46 34.000000 1648.0000 0.0000
5160 2884.250000 113858.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5226 2929.500000 116024.6100 0.0000
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6106 3722.250000 159326.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6112 3726.750000 159587.9300 50.0000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 2 1.750000 64.7500 64.7500
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
3880 2042.406133 77709.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3882 2044.156133 77774.2200 64.7500
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3302 2978.750000 111898.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3302 2978.750000 111898.4300 0.0000