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
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 11771 15222.75000 562845.2500 36.9740
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 380 331.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20762 63021.00000 2330418.7500 36.9784
Subtotal (Total Children Is Unduplicated) 22218 78575.00000 2893264.0000 36.8217
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 9 12.000000 582.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 39 46.250000 2312.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 27 49.000000 2450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 84 117.750000 5887.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 56.500000 4198.5000 74.3097
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 83 143.500000 10606.5000 73.9129
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 23.000000 1725.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 45 75.000000 5625.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 14 26.500000 1987.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 18 29.000000 2175.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 23 42.000000 3150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 33 52.000000 3900.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 40 66.500000 3774.0000 56.7519
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 77 130.500000 7242.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 395 757.000000 56435.0000 74.5509
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1461 2623.000000 196276.5500 74.8290
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 181 346.500000 25877.0000 74.6811
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 767 1295.500000 97102.5000 74.9537
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 164 325.000000 24375.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 412 737.000000 55237.5000 74.9491
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 514 987.000000 54697.2500 55.4177
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1681 3054.500000 169108.5500 55.3637
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 251 496.000100 37170.7575 74.9410
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 581 1007.000000 75525.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 70 70.000000 6819.6900 97.4241
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 140.5200 23.4200
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 103.1500 34.3833
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167TLGT-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 3 3.000000 153.1500 51.0500
PSTF-97164TL-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161TL-PT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
SCREEN-T1023-SCREENING 22 23.000000 1150.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 23 23.000000 1174.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 3973 12663.00010 858850.8675 67.8236
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 75 81.750000 4087.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 239 260.000000 13000.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 32.750000 818.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 107 126.000000 6300.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 656 613.500000 30625.0000 49.9185
CONIP-CONIP-CONSULT, ITDS PHONE 3 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 41 32.750000 1637.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 590 381.250000 19025.0000 49.9016
CONOP-CONOP-CONSULT, OT, PHONE 13 8.750000 218.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 30 27.500000 1375.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 390 191.750000 9587.5000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 83 76.750000 3837.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 514 328.500000 16412.5000 49.9619
CONSP-CONSP-CONSULT, SLP, PHONE 11 7.750000 193.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 439 813.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 6.000000 150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 340 1315.500000 65515.0000 49.8024
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 680 2227.750000 111337.5000 49.9776
INTR-T1013-INTERPRETER 75 207.000000 10350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 290 1141.000000 11410.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 41 72.000000 5143.6800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 102 382.250000 27307.9400 71.4400
OCCT-97530TL-OT SESSION BY LICENSED OT 24 50.250000 3589.8600 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 112 386.500000 27550.8300 71.2829
PHY-97110-PT SESSION BY LICENSED PT 70 197.500000 14109.4000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 50 170.750000 12279.3600 71.9143
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
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-97110TL-PT SESSION BY LICENSED PT 44 122.000000 8715.6800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 76 300.500000 21467.7200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 180 714.250000 50584.2600 70.8215
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 131 521.500000 37216.2600 71.3639
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 74 288.250000 20592.5800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 136 565.750000 40359.6200 71.3383
SPL-92508-GROUP SPL SESSION PER CHILD 2 2.000000 27.7600 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 113 113.750000 4208.7500 37.0000
TRAV-TRAVS-Travel by mile 210 12416.00000 5524.5000 0.4450
Subtotal (Total Children Is Unduplicated) 2663 24186.50000 584653.2000 24.1727
-----------------------------------------------------------------------------------------------------------------------
Total 115424.500100 4336768.0675 37.5723
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22612
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.000000 121.4400 0.0000
S 4474 2710.500000 118830.2200 0.0000
H 140 167.500000 10907.6400 0.0000
T 1 0.500000 18.5000 0.0000
2320 1357.500000 58980.4800 0.0000
Other 44 19.500000 834.5000 0.0000
---------------------------------------------------------
Total 6983 4258.000000 189711.2800 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 3611 2200.250000 94398.5000 0.0000
---------------------------------------------------------
Total 3611 2200.250000 94398.5000 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 158 122.250000 4746.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2608 1919.000000 91256.1000 18.5000
P 110 99.250000 5086.7000 5086.7000
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
4640 3523.000000 157855.0200 0.0000
Other 13 8.250000 311.7500 0.0000
---------------------------------------------------------
Total 7529 5671.750000 259256.0700 5105.2000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 163 287.000000 11854.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 404 597.000000 28425.0000 0.0000
P 621 1045.000000 44633.7500 44215.5400
D 24 37.250000 1955.5000 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
4974 6808.500000 277490.9600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6186 8774.750000 364359.9600 44215.5400
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 242 162.750000 6021.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2661 1814.500000 69049.2700 36810.5700
P 21 31.000000 1748.7200 1748.7200
D 2 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
2205 1339.250000 48636.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5131 3348.000000 125474.7400 38559.2900
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
12228 8356.500000 344611.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12228 8356.500000 344611.2500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 312 221.000000 8177.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 649 534.000000 23563.7500 0.0000
P 2838 2374.119900 101892.4925 101920.2300
D 22 26.000000 1607.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 20 38.500000 2868.5000 0.0000
T 0 0.000000 0.0000 0.0000
7157 3908.130200 146019.5150 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10998 7101.750100 284128.2575 101920.2300
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 285 283.500000 10593.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 913 924.250000 35993.7500 0.0000
P 10041 9787.500000 383096.5200 383262.3100
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 189 319.500000 17838.7500 0.0000
T 10 17.500000 1134.3800 335.7200
3858 3625.000000 141870.9300 47.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15296 14957.250000 590527.5800 383645.8900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 291 253.500000 9727.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 7834 6622.250000 277472.7500 0.0000
P 18 26.500000 1512.5000 669.5000
D 114 82.000000 3243.0000 0.0000
S 108 208.000000 14332.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4736 4368.500000 194705.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13101 11560.750000 500993.5000 669.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 67 70.000000 4372.5000 0.0000
P 1 1.000000 55.5000 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
590 590.750000 26065.4000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 658 661.750000 30493.4000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 217 249.500000 14033.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 1391 1322.500000 57648.7600 111.0000
P 1332 1291.000000 56564.7800 55029.9000
D 83 99.500000 5284.5000 0.0000
S 273 242.000000 10355.9600 0.0000
H 160 215.500000 14242.4200 115.0000
T 1133 13547.500000 37478.2900 31280.4000
2884 1938.250000 70731.3700 115.0000
Other 1 2.500000 92.5000 0.0000
---------------------------------------------------------
Total 7474 18908.250000 266432.4800 86651.3000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2317 2083.500000 100236.3400 0.0000
U 0 0.000000 0.0000 0.0000
B 1562 1324.750000 64236.9300 0.0000
P 1095 995.250000 46997.0400 46997.0400
D 41 42.250000 2533.0300 0.0000
S 159 166.750000 10784.0100 0.0000
H 0 0.000000 0.0000 0.0000
T 1 2.000000 74.0000 0.0000
6896 4256.500000 176131.5100 0.0000
Other 48 48.750000 3154.3700 0.0000
---------------------------------------------------------
Total 12119 8919.750000 404147.2300 46997.0400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 63 47.500000 2559.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 1590 1317.750000 58537.8400 87.0000
P 1687 1453.000000 65553.3400 72251.7900
D 13 14.500000 1028.1400 0.0000
S 14 16.750000 1214.7100 0.0000
H 1 0.250000 9.2500 9.2500
T 0 0.000000 0.0000 0.0000
9755 6686.000000 296989.4500 0.0000
Other 57 52.000000 3450.0600 69.2500
---------------------------------------------------------
Total 13180 9587.750000 429342.4300 72417.2900
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3801 3060.750000 126864.8700 0.0000
P 9 8.250000 305.2500 305.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 68 99.000000 7212.4500 0.0000
T 0 0.000000 0.0000 0.0000
4235 2312.500000 89792.1300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8113 5480.500000 224174.7000 305.2500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 444 616.750000 22961.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 595 773.500000 32349.2500 46.2500
P 1326 1639.250000 68429.0000 67559.8500
D 10 17.500000 704.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.500000 187.5000 0.0000
T 2 2.250000 96.2500 96.2500
2941 2508.000000 101111.6900 0.0000
Other 55 77.750000 2876.7500 1600.2500
---------------------------------------------------------
Total 5375 5637.500000 228716.6900 69302.6000