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
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 11770 15222.25000 562826.7500 36.9740
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 380 331.250000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7039 21701.00000 802171.2500 36.9647
Subtotal (Total Children Is Unduplicated) 15376 37254.50000 1364998.0000 36.6398
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 10.000000 485.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 38 45.250000 2262.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 25 46.500000 2325.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 84 117.750000 5887.5000 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 6 10.000000 750.0000 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 2 3.500000 262.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 6.000000 450.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 9.500000 712.5000 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 4 7.500000 416.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 26.500000 1470.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 40 75.500000 5662.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 153 262.500000 19687.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 60.500000 4537.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 133 209.500000 15712.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 24 51.500000 3862.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 57 98.500000 7387.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 112 214.000000 11877.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 417 658.500000 36546.7500 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 115.302400 8647.6800 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 130 198.577800 14893.3350 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
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 3 3.000000 150.0000 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 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 969 2306.380200 148783.4650 64.5095
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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 589 380.250000 18975.0000 49.9014
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 513 327.500000 16362.5000 49.9618
CONSP-CONSP-CONSULT, SLP, PHONE 11 7.750000 193.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 438 811.250000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 1 1.000000 25.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 50 176.750000 8837.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 132 285.750000 14287.5000 50.0000
INTR-T1013-INTERPRETER 75 207.000000 10350.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 290 1140.000000 11400.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 6.000000 428.6400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 22 77.000000 5500.8800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 44.000000 3143.3600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 16 49.750000 3554.1400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 108.250000 7733.3800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 38 197.750000 14127.2600 71.4400
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) 2002 17805.00000 196233.4100 11.0213
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Total 57365.880200 1710014.8750 29.8089
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Number of Children (Unduplicated) With at Least One Service 16048
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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 0 0.000000 0.0000 0.0000
S 23 15.500000 573.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2245 1296.250000 55449.3700 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 2269 1312.000000 56032.1200 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 2433 1277.500000 52716.2500 0.0000
---------------------------------------------------------
Total 2433 1277.500000 52716.2500 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
4014 2756.500000 102662.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4014 2756.500000 102662.7800 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 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
2701 2956.500000 122400.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2701 2956.500000 122400.7000 0.0000
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 21 31.000000 1748.7200 1748.7200
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
2199 1335.000000 48479.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2220 1366.000000 50227.9700 1748.7200
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
5627 3073.000000 114231.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5627 3073.000000 114231.2500 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 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
7083 3785.630200 137695.0150 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7104 3809.630200 139152.0150 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 7054 6491.500000 246999.4400 246999.4400
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
3760 3481.000000 132250.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10814 9972.500000 379250.1800 246999.4400
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 1 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
4314 3430.500000 130375.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4315 3431.000000 130394.2500 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 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
418 373.500000 15604.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 418 373.500000 15604.7400 0.0000
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 1 2.000000 111.0000 0.0000
S 1 0.750000 27.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 930 13308.500000 23150.2100 20880.3700
2682 1706.750000 58490.2500 20.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3614 15018.000000 81779.2100 20900.3700
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 0 0.000000 0.0000 0.0000
6279 3547.500000 132555.2300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6287 3555.500000 132888.2300 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 1 0.250000 9.2500 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
6682 3934.000000 162099.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6683 3934.250000 162108.3600 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
4102 2180.500000 82433.5700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4102 2180.500000 82433.5700 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 17 24.250000 897.2500 0.0000
P 6 20.000000 740.0000 344.1000
D 3 3.250000 177.2500 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
2752 2224.250000 83442.0000 0.0000
Other 55 77.750000 2876.7500 1600.2500
---------------------------------------------------------
Total 2833 2349.500000 88133.2500 1944.3500