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
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 11799 18196.00000 673049.0000 36.9888
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 298 239.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7332 25480.50000 942612.0000 36.9935
Subtotal (Total Children Is Unduplicated) 15533 43916.00000 1615661.0000 36.7898
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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 22 43.000000 2150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 120 145.889800 7294.4900 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 15.836800 1187.7600 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 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 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 5 13.500000 749.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 31 50.000000 2775.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 24 40.222100 3016.6575 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 167 288.515300 21638.6475 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 12 22.500000 1687.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 158 255.000000 19125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 9 15.077800 1130.8350 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 67 126.500000 9487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 59 121.000000 6715.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 490 768.500000 42651.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 22 44.060900 3304.5675 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 149 255.804800 19185.3600 75.0000
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
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
SCREEN-T1023-SCREENING 4 4.000000 200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
Subtotal (Total Children Is Unduplicated) 1065 2383.657500 152342.7475 63.9113
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 360.0000 360.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 102 101.250000 5062.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 303 334.500000 16700.0000 49.9253
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 652 592.500000 29538.0000 49.8532
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 567 341.500000 17062.5000 49.9634
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 413 200.500000 10000.0000 49.8753
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 252 464.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 31 129.750000 6487.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 151 378.250000 18912.5000 50.0000
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 3 6.750000 482.2200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 16 45.250000 3232.6600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 7 16.750000 1196.6200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 15 74.500000 5322.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 133.000000 9501.5200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 41 205.250000 14663.0600 71.4400
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) 1973 17001.25000 207167.7700 12.1854
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Total 63300.907500 1975171.5175 31.2029
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 16092
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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 3.000000 171.4400 0.0000
S 17 6.250000 231.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5265 3128.500000 129320.4800 0.0000
Other 42 20.000000 777.0000 0.0000
---------------------------------------------------------
Total 5327 3157.750000 130500.1700 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 1 1.000000 360.0000 0.0000
1 0.250000 9.2500 0.0000
Other 2603 1342.750000 55377.7500 0.0000
---------------------------------------------------------
Total 2605 1344.000000 55747.0000 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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5613 3575.000000 146971.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5613 3575.000000 146971.5700 0.0000
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 1 2.000000 74.0000 100.0000
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
3210 3228.250000 133075.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3211 3230.250000 133149.7800 100.0000
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 36 54.750000 3083.4600 3083.4600
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
2246 1392.000000 50948.5000 55.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2282 1446.750000 54031.9600 3138.4600
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
6307 3349.000000 124937.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6307 3349.000000 124937.5000 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 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
8290 4283.162900 156140.4675 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8325 4320.912900 158219.2175 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 10067 9064.000000 343358.0300 343358.0300
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
65 54.500000 2066.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10132 9118.500000 345424.5300 343358.0300
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 4 2.250000 83.2500 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
4808 3696.000000 139906.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4812 3698.250000 139989.7500 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 1 2.000000 20.0000 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
768 603.500000 24209.1000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 769 605.500000 24229.1000 20.0000
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 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 1029 12952.000000 23555.0100 21605.1500
2462 1567.000000 55211.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3555 14573.750000 80883.5100 21614.4000
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 2 1.500000 75.0000 0.0000
5792 3206.750000 126925.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5835 3236.500000 128103.9400 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 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 0 0.000000 0.0000 0.0000
6558 3832.000000 160783.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6564 3834.500000 160910.9200 0.0000
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 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
4413 2517.994600 96459.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4413 2517.994600 96459.4400 0.0000
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
2766 5290.500000 195548.3800 0.0000
Other 1 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 2767 5292.250000 195613.1300 0.0000