CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 11778 15242.25000 563566.7500 36.9740
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 380 331.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7052 21734.25000 803401.5000 36.9648
Subtotal (Total Children Is Unduplicated) 15393 37307.75000 1366968.2500 36.6403
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 18.000000 873.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 2 2.000000 38.7400 19.3700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 5 6.000000 84.6400 14.1067
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 5 6.000000 55.9000 9.3167
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 6.000000 168.7600 28.1267
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 2 2.000000 33.4000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 2 2.000000 41.7800 20.8900
EVAL-96111-DEVELOPMENTAL EVALUATION 40 49.250000 2462.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 29 57.250000 2862.5000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 287 499.000000 24950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 5 7.500000 562.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 7 12.000000 900.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 12.000000 900.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 4.000000 300.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 6 8.500000 637.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 12.500000 937.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 7.500000 562.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 20 30.000000 1665.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 20 33.500000 1859.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 56 100.968266 7572.6200 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 235 399.833333 29902.0900 74.7864
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 40 77.000000 5775.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 153 240.866667 18065.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 33 66.500000 4987.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 107 191.000000 14325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 152 288.500000 16011.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 511 836.000000 46398.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 67 131.802400 9885.1800 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 151 239.577800 17968.3350 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 35.000000 2061.8500 58.9100
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 117.1000 23.4200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 4.000000 200.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 3 8.000000 400.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
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-97167-OT EVAL HIGH COMPLEXITY 18 18.000000 827.0000 45.9444
OCTH-97167GT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97162GT-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 10 10.000000 510.5000 51.0500
PSTH-97163GT-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 3 3.000000 150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 21 19.530852 972.0500 49.7700
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 5 5.000000 224.5800 44.9160
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1437 3481.579318 217818.9750 62.5633
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 9 16.000000 2198.9000 137.4313
AUD-92593TS-AUDIOLOGY SERVICES (Biaural) 1 2.000000 100.0000 50.0000
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 487 656.500000 26637.5000 40.5750
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 787 843.500000 42175.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 209 214.750000 5362.5000 24.9709
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 557 759.000000 35475.0000 46.7391
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 1070 1188.000000 59350.0000 49.9579
CONIP-CONIP-CONSULT, ITDS PHONE 120 115.500000 2887.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 377 462.750000 23137.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 877 688.750000 34400.0000 49.9456
CONOP-CONOP-CONSULT, OT, PHONE 62 110.250000 2756.2500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 138 164.000000 8200.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 522 335.500000 16775.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 4.000000 100.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 471 544.750000 27237.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 962 857.500000 42862.5000 49.9854
CONSP-CONSP-CONSULT, SLP, PHONE 86 72.250000 1806.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 438 811.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 3 5.500000 137.5000 25.0000
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1809 10005.75000 499149.9100 49.8863
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 695 3249.750000 162487.5000 50.0000
INTR-T1013-INTERPRETER 209 811.750000 43616.0000 53.7308
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 8792 61770.00000 616394.1700 9.9789
OCCT-97530-OT SESSION BY LICENSED OT 176 798.970606 55667.8600 69.6745
OCCT-97530GT-OT SESSION BY LICENSED OT 34 105.000000 7476.2000 71.2019
OCCT-97530HM-OT SESSION BY OT ASST 28 141.378321 8074.5400 57.1130
OCCT-97530HMGT-OT SESSION BY OT ASST 1 2.000000 114.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 188 852.689391 60394.2101 70.8279
PHY-97110GT-PT SESSION BY LICENSED PT 37 106.500000 7468.8800 70.1303
PHY-97110HM-PT SESSION BY PT ASST 14 73.562280 4204.8200 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 4.000000 228.6400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 449 2263.728442 156886.6000 69.3045
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 118 412.500000 29248.4200 70.9053
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 181 205.500000 7603.5000 37.0000
TRAV-TRAVS-Travel by mile 2850 222033.0000 97884.3800 0.4409
Subtotal (Total Children Is Unduplicated) 12388 310687.8290 2088498.9301 6.7222
-----------------------------------------------------------------------------------------------------------------------
Total 351477.158358 3673286.1551 10.4510
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20376
-----------------------------------------------------------------------------------------------------------------------
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 8763 33330.750000 131429.2100 131429.2100
D 1397 13553.500000 12510.2300 0.0000
S 23 15.500000 573.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 5355 21569.750000 73258.7100 73248.7100
2263 1375.750000 56256.0600 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 17802 69845.500000 274036.9600 204677.9200
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 1 1.000000 10.0000 10.0000
H 0 0.000000 0.0000 0.0000
T 2122 7335.750000 51033.8500 50816.3500
751 1208.500000 16123.6000 50.0000
Other 2433 1277.500000 52716.2500 0.0000
---------------------------------------------------------
Total 5307 9822.750000 119883.7000 50876.3500
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 176 2180.500000 4204.7600 4204.7600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 285 1911.250000 7213.9600 7213.9600
T 0 0.000000 0.0000 0.0000
7173 31130.500000 186682.8100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7634 35222.250000 198101.5300 11418.7200
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 2150 8189.000000 127443.3600 127443.3600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 17 53.000000 650.0000 650.0000
T 0 0.000000 0.0000 0.0000
2722 2971.250000 122946.4500 0.0000
Other 4 9.000000 250.0000 250.0000
---------------------------------------------------------
Total 4893 11222.250000 251289.8100 128343.3600
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 3632 20826.500000 114359.7600 114359.7600
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
2872 5355.500000 73675.2900 25196.0400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6504 26182.000000 188035.0500 139555.8000
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 3345 3318.750000 60989.9600 60989.9600
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
10924 8413.500000 222475.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14269 11732.250000 283465.4600 60989.9600
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 3294 9556.250000 178045.6300 178055.6300
D 15 12.000000 557.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 6 12.000000 900.0000 0.0000
T 0 0.000000 0.0000 0.0000
7084 3786.630200 137705.0150 10.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10399 13366.880200 317207.6450 178065.6300
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 9908 69043.500000 505066.1400 505066.1400
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
4144 12657.750000 171565.9000 0.0000
Other 18 36.000000 2427.0000 0.0000
---------------------------------------------------------
Total 14070 81737.250000 679059.0400 505066.1400
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 4012 13148.500000 295493.3300 295493.3300
D 7 20.500000 341.3800 0.0000
S 35 55.000000 1317.1600 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4314 3430.500000 130375.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8368 16654.500000 427527.6200 295493.3300
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 1218 6047.000000 86624.4100 86624.4100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 120.0000 120.0000
T 0 0.000000 0.0000 0.0000
419 376.500000 15819.0600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1640 6435.500000 102563.4700 86744.4100
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 1 2.000000 111.0000 0.0000
S 1 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 2975 35232.500000 68055.5700 65785.7300
2682 1706.750000 58490.2500 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5659 36942.000000 126684.5700 65805.7300
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 6 5.250000 231.2500 0.0000
S 2 2.750000 101.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 101 283.000000 4885.8700 4885.8700
6344 4021.000000 134706.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6453 4312.000000 139925.5300 4885.8700
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 1 0.250000 9.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 343 388.500000 16912.8500 16912.8500
6871 4503.750000 168894.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7215 4892.500000 185816.2200 16912.8500
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 4463 6549.516439 71920.3001 71920.3000
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
5400 4257.011719 107047.6600 105.9300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9863 10806.528158 178967.9601 72026.2300
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 17 24.250000 897.2500 0.0000
P 6 20.000000 740.0000 344.1000
D 3 3.250000 177.2500 0.0000
S 58 237.000000 2164.9700 2164.9700
H 0 0.000000 0.0000 0.0000
T 2381 9678.500000 109044.3700 109044.3700
2790 2261.250000 84811.0000 0.0000
Other 56 78.750000 2886.7500 1610.2500
---------------------------------------------------------
Total 5311 12303.000000 200721.5900 113163.6900