CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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 11820 18218.25000 673872.2500 36.9889
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 298 239.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7350 25516.75000 943953.2500 36.9935
Subtotal (Total Children Is Unduplicated) 15566 43974.50000 1617825.5000 36.7901
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 30 31.000000 1503.5000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 39.0800 19.5400
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 6 7.000000 98.5100 14.0729
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 7 8.000000 74.0600 9.2575
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 6 7.000000 196.5900 28.0843
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.7800 20.8900
AUDE-V5010-ASSESSMENT FOR HEARING AID 1 1.000000 45.0000 45.0000
AUDE-V5090-DISPENSING FEE PER HEARING AID 1 2.000000 230.0000 115.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 56 62.250000 3112.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 23 45.000000 2250.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 386 611.639800 30581.9900 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 10.000000 750.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 14 22.336800 1675.2600 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 11 15.500000 1162.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 3 5.000000 375.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 4.000000 300.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 30 55.500000 3080.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 40 66.000000 3663.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 47 84.222100 6119.2375 72.6560
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 247 439.015300 32611.4075 74.2831
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 26 49.500000 3712.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 186 309.500000 23212.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 16.577800 1243.3350 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 127 236.895733 17767.1800 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 108 211.500000 11738.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 636 1066.500000 59190.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 29 58.060900 4354.5675 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 165 288.304800 21572.8600 74.8266
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 59 59.000000 3475.6900 58.9100
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 6.000000 300.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 2 6.000000 300.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 6 6.000000 293.5000 48.9167
OCTH-97167-OT EVAL HIGH COMPLEXITY 34 34.000000 1559.6900 45.8732
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 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-97162-PT EVAL MODERATE COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 7.000000 357.3500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
SCREEN-T1023-SCREENING 5 5.000000 250.0000 50.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 34 34.000000 1735.7000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 408.4000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 4 3.000000 153.1400 51.0467
Subtotal (Total Children Is Unduplicated) 1695 3918.803233 241492.5175 61.6240
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 31 55.000000 15038.6000 273.4291
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 634 695.250000 34312.5000 49.3528
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 1012 1153.500000 57650.0000 49.9783
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 266 268.250000 6681.2500 24.9068
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 636 770.750000 38475.0000 49.9189
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1130 1344.500000 67138.0000 49.9353
CONIP-CONIP-CONSULT, ITDS PHONE 116 128.250000 3206.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 383 514.000000 25700.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 920 766.500000 38312.5000 49.9837
CONOP-CONOP-CONSULT, OT, PHONE 58 123.500000 3087.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 181 218.750000 10912.5000 49.8857
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 584 397.250000 19837.5000 49.9371
CONPP-CONPP-CONSULT, PT, PHONE 8 5.500000 137.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 530 613.750000 30662.5000 49.9593
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 1021 1034.000000 51700.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 100 96.250000 2406.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 252 464.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 4.500000 112.5000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1631 10521.00000 525565.0000 49.9539
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 858 4221.750000 210662.5000 49.8993
INTR-T1013-INTERPRETER 237 908.750000 46988.6200 51.7069
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2021 ending 03/31/2021 Date of Report:05/04/2021 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
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8305 70621.00000 706141.3200 9.9990
OCCT-97530-OT SESSION BY LICENSED OT 194 1000.290033 70279.9200 70.2595
OCCT-97530GT-OT SESSION BY LICENSED OT 48 144.500000 10091.9700 69.8406
OCCT-97530HM-OT SESSION BY OT ASST 33 212.500000 12155.0000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.750000 157.3000 57.2000
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 154 711.064810 49765.0300 69.9866
PHY-97110GT-PT SESSION BY LICENSED PT 51 206.389278 14476.5500 70.1420
PHY-97110HM-PT SESSION BY PT ASST 13 105.250000 6016.0900 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 3 8.091322 462.5000 57.1600
SENS-V5050-IN EAR MONAURAL HEARING AID 1 2.000000 456.0000 228.0000
SENS-V5264-EARMOLD 1 2.000000 36.0000 18.0000
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 462 2603.684634 182919.6300 70.2541
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 156 625.190088 44186.8700 70.6775
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 204 269.500000 9971.5000 37.0000
TRAV-TRAVS-Travel by mile 2512 218433.0000 95717.4100 0.4382
Subtotal (Total Children Is Unduplicated) 12036 319253.4602 2391491.0000 7.4909
-----------------------------------------------------------------------------------------------------------------------
Total 367146.763398 4250809.0175 11.5780
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20079
-----------------------------------------------------------------------------------------------------------------------
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 10690 37500.250000 172622.7100 172622.7100
D 949 9807.000000 10023.9300 237.5900
S 17 6.250000 231.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 1095 4877.250000 14970.2200 14970.2200
5288 3185.500000 131454.5700 150.0000
Other 43 22.000000 927.0000 150.0000
---------------------------------------------------------
Total 18082 55398.250000 330229.6800 188130.5200
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 2964 10300.750000 79468.0700 78987.2600
68 699.000000 1335.9600 0.0000
Other 2603 1342.750000 55377.7500 0.0000
---------------------------------------------------------
Total 5635 12342.500000 136181.7800 78987.2600
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 1665 13479.500000 45308.3000 45308.3000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 240.000000 697.6300 697.6300
T 0 0.000000 0.0000 0.0000
7694 21262.750000 201621.9200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9379 34982.250000 247627.8500 46005.9300
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 2861 10388.250000 169775.3500 169801.3500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 13 41.000000 718.8000 568.8000
T 0 0.000000 0.0000 0.0000
3292 3286.000000 135212.5300 0.0000
Other 3 8.000000 120.0000 120.0000
---------------------------------------------------------
Total 6169 13723.250000 305826.6800 170490.1500
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 4914 30969.750000 163366.3400 163366.3400
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
2336 1763.500000 55289.2000 4395.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7250 32733.250000 218655.5400 167762.0400
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 5817 5781.250000 116726.3500 116726.3500
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
10564 7588.250000 207054.9900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 16381 13369.500000 323781.3400 116726.3500
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 4894 14720.500000 257681.7500 257591.7500
D 30 27.750000 1328.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
8292 4284.412900 156199.7175 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13221 19042.662900 415960.2175 257591.7500
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 12780 66790.750000 622985.5300 622985.5300
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
327 6356.750000 27486.5600 0.0000
Other 9 70.000000 512.5800 0.0000
---------------------------------------------------------
Total 13116 73217.500000 650984.6700 622985.5300
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 4354 13616.750000 301607.1900 301607.1900
D 7 10.750000 238.9700 0.0000
S 33 42.500000 1260.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4809 3696.500000 139925.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9203 17366.500000 443031.1600 301607.1900
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 1263 7217.500000 91214.5800 91214.5800
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 1 2.000000 20.0000 20.0000
T 0 0.000000 0.0000 0.0000
768 603.500000 24209.1000 0.0000
Other 1 6.000000 60.0000 60.0000
---------------------------------------------------------
Total 2033 7829.000000 115503.6800 91294.5800
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 5 8.000000 433.0000 0.0000
S 59 46.750000 1684.0000 9.2500
H 0 0.000000 0.0000 0.0000
T 3847 43557.750000 90440.4900 88490.6300
2463 1627.000000 55238.2000 26.7000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6374 45239.500000 147795.6900 88526.5800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3 0.750000 34.2500 0.0000
P 0 0.000000 0.0000 0.0000
D 28 23.500000 869.5000 0.0000
S 10 4.000000 200.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 58 57.000000 2861.0000 2786.0000
5879 3356.750000 131245.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5978 3442.000000 135209.9800 2786.0000
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 6 2.500000 126.9400 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 376 390.500000 18664.9000 18664.9000
6817 4171.500000 176670.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7199 4564.500000 195462.3600 18664.9000
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 5334 9145.981458 86756.6200 86756.6200
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
6763 5315.119040 133762.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12097 14461.100498 220518.8000 86756.6200
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 42 152.000000 1583.0000 1583.0000
H 0 0.000000 0.0000 0.0000
T 3298 13988.750000 166729.0600 166729.0600
2767 5292.500000 195662.7800 114.4000
Other 1 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 6108 19435.000000 364039.5900 168426.4600