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
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 11799 18197.00000 673086.0000 36.9888
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 298 239.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21652 74637.75000 2760655.2500 36.9874
Subtotal (Total Children Is Unduplicated) 22686 93074.25000 3433741.2500 36.8925
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 17.000000 824.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 51 53.250000 2662.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 23 46.000000 2300.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 130 160.000600 8000.0300 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 40 71.500000 5362.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 79 136.000000 10200.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 46 72.500000 5398.5000 74.4621
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 33 64.000000 4800.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 34 62.000000 4650.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 45 75.000000 5625.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 54.500000 3024.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 92 166.000000 9213.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 246 464.500000 34779.0000 74.8741
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1554 2812.000000 210589.3200 74.8895
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 68 126.500000 9487.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 959 1590.000000 118992.2800 74.8379
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 76 143.000000 10725.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 464 824.000000 61725.0000 74.9090
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 313 607.000000 33688.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1945 3495.500000 193686.5700 55.4103
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 154 301.500000 22612.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 732 1265.500000 95223.3100 75.2456
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 89 90.000000 9058.0900 100.6454
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 5.000000 255.2500 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 2.000000 102.1000 51.0500
PSTH-97163TL-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163TLGT-PT EVAL HIGH COMPLEXITY 2 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 27 27.000000 1400.0000 51.8519
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 24 24.000000 1225.2000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 17.000000 852.8500 50.1676
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 8 8.000000 408.4000 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 3 3.000000 133.6500 44.5500
SPCH-92610TL-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
SPCH-92610TLGT-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUN 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 4162 12825.75060 869477.8900 67.7916
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 360.0000 360.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 104 103.250000 5162.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 305 336.500000 16800.0000 49.9257
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 41 44.000000 1100.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 129 146.750000 7337.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 653 593.500000 29588.0000 49.8534
CONIP-CONIP-CONSULT, ITDS PHONE 13 14.750000 368.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 44 49.500000 2475.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 567 343.500000 17162.5000 49.9636
CONOP-CONOP-CONSULT, OT, PHONE 4 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 53 58.750000 2937.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 414 207.500000 10350.0000 49.8795
CONPP-CONPP-CONSULT, PT, PHONE 1 0.250000 6.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 128 157.750000 7862.5000 49.8415
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 403 286.500000 14325.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 21 16.500000 412.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 253 468.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 279 1357.500000 67550.0000 49.7606
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 732 2504.500000 125175.0000 49.9800
INTR-T1013-INTERPRETER 76 219.000000 10950.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 193 1008.000000 10080.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 99.250000 7090.4200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 136 504.500000 36020.0400 71.3975
OCCT-97530TL-OT SESSION BY LICENSED OT 18 38.250000 2732.5800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 111 406.000000 28830.4600 71.0110
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
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-97110-PT SESSION BY LICENSED PT 61 126.250000 9019.3000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 75 295.250000 21092.6600 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 24 58.500000 4179.2400 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 77 306.250000 21878.5000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 177 818.750000 56732.1600 69.2912
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 171 653.500000 46656.0400 71.3941
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 67 356.750000 25486.2200 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 118 554.500000 39592.0400 71.4013
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 112 145.500000 5383.5000 37.0000
TRAV-TRAVS-Travel by mile 191 11825.00000 5261.4700 0.4449
Subtotal (Total Children Is Unduplicated) 2653 24108.75000 640032.6300 26.5477
-----------------------------------------------------------------------------------------------------------------------
Total 130008.750600 4943251.7700 38.0225
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22900
-----------------------------------------------------------------------------------------------------------------------
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 4 4.000000 242.8800 0.0000
S 5922 3781.750000 166965.4600 0.0000
H 4454 2789.750000 124961.7500 100414.1100
T 1 0.250000 9.2500 0.0000
5412 3282.000000 139018.9900 0.0000
Other 100 45.250000 1988.7500 0.0000
---------------------------------------------------------
Total 15893 9903.000000 433187.0800 100414.1100
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 1 1.000000 360.0000 0.0000
1 0.250000 9.2500 0.0000
Other 3866 2332.000000 99764.0000 0.0000
---------------------------------------------------------
Total 3868 2333.250000 100133.2500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 22 23.500000 882.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 4215 3007.000000 127861.2600 0.0000
P 224 187.750000 8548.8900 8548.8900
D 5 5.000000 336.8100 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
6172 4254.000000 195870.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10638 7477.250000 333499.5700 8548.8900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 103 148.000000 6175.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1716 2862.250000 112649.7500 64.7500
P 1961 3289.000000 122440.6300 121353.3500
D 42 65.500000 4462.5000 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
3785 3896.500000 178649.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7607 10261.250000 424377.2400 121418.1000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 16 10.750000 439.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 3030 2006.500000 76397.5200 52349.3600
P 36 54.750000 3083.4600 3083.4600
D 1 0.750000 27.7500 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
2247 1393.000000 50985.5000 55.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5330 3465.750000 130934.1300 55487.8200
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
12742 8099.250000 326237.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12742 8099.250000 326237.2500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 39 38.000000 1519.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 411 327.500000 12679.2500 0.0000
P 3741 3021.587100 127763.0325 128513.5800
D 40 47.750000 2828.7500 0.0000
S 0 0.000000 0.0000 0.0000
H 18 36.000000 2700.0000 0.0000
T 0 0.000000 0.0000 0.0000
8334 4362.662900 161630.9675 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12583 7833.500000 309121.0000 128513.5800
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 10.750000 397.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 143 143.500000 5744.3500 18.5000
P 13603 12959.250000 504942.1900 507273.4000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 114 207.000000 11557.5000 0.0000
T 5 4.750000 175.9300 330.4400
431 462.000000 19782.3700 0.0000
Other 1 1.500000 112.5000 0.0000
---------------------------------------------------------
Total 14305 13788.750000 542712.5900 507622.3400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 51.500000 1942.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2722 2062.500000 79751.0000 18.5000
P 7842 6431.000000 268270.5000 267769.4900
D 61 45.250000 2107.2500 411.0000
S 88 171.500000 11556.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5102 4389.500000 187541.2500 0.0000
Other 2 0.500000 18.5000 18.5000
---------------------------------------------------------
Total 15884 13151.750000 551187.0000 268217.4900
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 90 89.500000 5267.0000 0.0000
P 3 5.000000 170.0000 20.0000
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
1120 985.750000 40323.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1213 1080.250000 45760.2700 20.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 4.250000 187.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 310 337.000000 18788.1000 0.0000
P 2376 2303.750000 102827.2600 101751.6100
D 113 144.250000 7706.8200 0.0000
S 371 375.750000 15630.9400 18.5000
H 217 287.750000 19108.4600 71.4400
T 1280 13235.000000 41110.2300 33539.2300
2552 1689.000000 63520.8200 2405.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7223 18376.750000 268879.6300 137785.7800
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 49.250000 1960.0100 0.0000
U 0 0.000000 0.0000 0.0000
B 2648 2398.750000 115675.9900 0.0000
P 2111 1860.250000 88710.3500 88710.3500
D 253 197.500000 10146.8600 0.0000
S 87 65.000000 2880.7600 0.0000
H 0 0.000000 0.0000 0.0000
T 2 1.500000 75.0000 0.0000
6397 3877.750000 169895.9200 0.0000
Other 42 39.500000 2390.2300 92.5000
---------------------------------------------------------
Total 11589 8489.500000 391735.1200 88802.8500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 7.000000 272.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3162 2767.500000 127226.3200 0.0000
P 2790 2396.000000 107029.4600 107010.9600
D 128 121.250000 5432.9300 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
6995 4305.250000 194081.7000 0.0000
Other 40 37.750000 2392.1900 101.7500
---------------------------------------------------------
Total 13123 9634.750000 436434.6000 107112.7100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3868 3167.250000 134330.7300 0.0000
P 207 159.000000 6339.0000 6237.2620
D 0 0.000000 0.0000 0.0000
S 3 4.666666 274.0000 0.0000
H 65 88.500000 6294.5400 0.0000
T 0 0.000000 0.0000 0.0000
4484 2613.583934 103022.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8627 6033.000600 250260.3800 6237.2620
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 6.500000 257.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 146 167.750000 6724.2900 0.0000
P 3462 4267.750000 172856.2200 170994.5200
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
3008 5637.000000 218889.6800 0.0000
Other 1 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 6623 10080.750000 398792.6600 170994.5200