CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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 11036 14741.75000 545187.0000 36.9825
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 304 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6755 28268.75000 1045140.2500 36.9716
Subtotal (Total Children Is Unduplicated) 14461 43302.25000 1590327.2500 36.7262
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 13 14.000000 679.0000 48.5000
AUDE-92552-PURE TONE AUDIOMETRY -AIR ONLY 1 1.000000 19.3700 19.3700
AUDE-92555-SPEECH AUD THRESHOLD (DETECTION) 4 4.000000 56.1900 14.0475
AUDE-92567-TYPMANOMETRY (IMPEDANCE TESTING) 4 4.000000 37.0300 9.2575
AUDE-92579-VISUAL REINFORCEMENT AUDIOMETRY 5 5.000000 140.0400 28.0080
AUDE-92587-OTOACOUSTIC EMISSIONS (LIMITED) 1 1.000000 16.7000 16.7000
AUDE-92588-OTOACOUSTIC EMISSIONS (COMP) 1 1.000000 20.8900 20.8900
EVAL-96111-DEVELOPMENTAL EVALUATION 48 63.389200 3191.4600 50.3471
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 5.000000 250.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 243 388.389200 19419.4600 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 19 32.336800 2425.2600 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 11.500000 862.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 3.000000 225.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 2 3.000000 225.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 8 12.500000 937.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 31.000000 1720.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 38 65.000000 3607.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 87 162.000000 12150.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 273 473.613867 35521.0400 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 44 78.500000 5887.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 120 194.500000 14587.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 41 73.500000 5512.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 92 159.000000 11925.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 231 437.500000 24281.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 471 786.500000 43623.0000 55.4647
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 100 199.000000 14886.0000 74.8040
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 194.000000 14550.0000 75.0000
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 2 2.000000 60.7000 30.3500
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 35 35.000000 2061.8500 58.9100
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 23.4200 23.4200
NUTR-97802-NUTRITIONAL EVAL, INITIAL 2 5.000000 250.0000 50.0000
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 1 2.000000 100.0000 50.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 3.397258 173.4300 51.0500
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 15 15.000000 747.3400 49.8227
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 4 6.000000 303.1500 50.5250
PSTH-97163-PT EVAL HIGH COMPLEXITY 7 6.303624 296.5400 47.0428
SCREEN-T1023-SCREENING 2 2.000000 100.0000 50.0000
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 27 29.000000 1440.4500 49.6707
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 8 8.000000 408.4000 51.0500
Subtotal (Total Children Is Unduplicated) 1464 3553.929949 225135.0700 63.3482
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 12 15.000000 1564.6100 104.3073
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 562 640.500000 32012.5000 49.9805
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 770 1803.250000 40162.5000 22.2723
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 185 173.000000 4325.0000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 603 747.750000 37375.0000 49.9833
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 922 938.250000 46912.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 123 105.250000 2631.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 385 472.000000 23600.0000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 750 588.000000 29400.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 50 70.000000 1750.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 163 187.000000 9350.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 465 279.000000 13950.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 7 5.250000 131.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 476 596.750000 29837.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 812 708.500000 35425.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 101 82.000000 2050.0000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 617 1026.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 4 4.750000 118.7500 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1778 8852.250000 442317.5000 49.9667
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 662 3042.250000 152112.5000 50.0000
INTR-T1013-INTERPRETER 245 762.500000 38524.0000 50.5233
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 9169 57968.00000 579384.6800 9.9949
OCCT-97530-OT SESSION BY LICENSED OT 147 616.509374 41857.7400 67.8947
OCCT-97530GT-OT SESSION BY LICENSED OT 29 76.250000 5447.3000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 38 141.740383 8101.4000 57.1566
OCCT-97530HMGT-OT SESSION BY OT ASST 2 2.000000 114.4000 57.2000
OCCT-97530TL-OT SESSION BY LICENSED OT 1 0.750000 53.5800 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 141 541.759658 37241.5200 68.7418
PHY-97110GT-PT SESSION BY LICENSED PT 24 103.500000 7394.0400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 22 89.892233 5138.2400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 2.500000 142.9000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 361 1469.443307 101607.2200 69.1467
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 88 276.000000 19627.4400 71.1139
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 3 2.500000 143.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 198 215.250000 7964.2500 37.0000
TRAV-TRAVS-Travel by mile 2657 187663.0000 82638.1300 0.4404
Subtotal (Total Children Is Unduplicated) 12476 270272.8450 1840518.7800 6.8099
-----------------------------------------------------------------------------------------------------------------------
Total 317129.024904 3655981.1000 11.5284
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20433
-----------------------------------------------------------------------------------------------------------------------
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 7989 31367.000000 110561.6600 110561.6600
D 1213 11988.500000 12518.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2976 13554.750000 42853.4400 42834.4400
672 690.250000 37712.7900 0.0000
Other 6 6.000000 279.0000 0.0000
---------------------------------------------------------
Total 12856 57606.500000 203925.2900 153396.1000
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 7 7.500000 235.0000 272.5000
H 0 0.000000 0.0000 0.0000
T 2594 10936.000000 53866.8700 53806.8800
282 1383.250000 6241.4600 0.0000
Other 2622 1404.250000 54205.7700 0.0000
---------------------------------------------------------
Total 5505 13731.000000 114549.1000 54079.3800
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
7780 41899.500000 204894.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7780 41899.500000 204894.2900 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 2071 7470.500000 120055.0200 120082.7700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 19 69.000000 810.0000 660.0000
T 0 0.000000 0.0000 0.0000
2825 6564.500000 253374.4700 0.0000
Other 12 51.000000 1401.6400 1574.3200
---------------------------------------------------------
Total 4927 14155.000000 375641.1300 122317.0900
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 3919 20468.500000 131655.4800 131655.4800
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
2400 2097.500000 53659.3800 5143.1300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6319 22566.000000 185314.8600 136798.6100
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 6995 6972.250000 133276.0900 133276.0900
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
7123 4632.000000 146951.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14118 11604.250000 280227.8700 133276.0900
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 3350 9096.500000 172062.7500 171912.7500
D 28 18.250000 827.2500 0.0000
S 1 0.250000 9.2500 0.0000
H 13 26.000000 1950.0000 0.0000
T 0 0.000000 0.0000 0.0000
6838 3655.750000 132342.2500 50.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10230 12796.750000 307191.5000 171962.7500
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 8317 41784.750000 352269.1800 352269.1800
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
3561 3554.500000 125386.2100 0.0000
Other 13 25.500000 1766.2500 0.0000
---------------------------------------------------------
Total 11891 45364.750000 479421.6400 352269.1800
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 3948 12098.500000 280229.1000 280029.1000
D 0 0.000000 0.0000 0.0000
S 31 45.500000 1102.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4438 3806.750000 154741.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8417 15950.750000 436073.1000 280029.1000
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 1383 5091.250000 92279.1900 92279.1900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 3 12.000000 488.6400 488.6400
T 0 0.000000 0.0000 0.0000
591 475.250000 18602.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1977 5578.500000 111370.2900 92767.8300
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 8 2.000000 74.0000 74.0000
D 6 5.500000 250.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 3191 34530.250000 70037.5800 68035.2100
2675 1650.500000 54140.7900 39.7900
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5880 36188.250000 124502.3700 68149.0000
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 1 0.500000 18.5000 0.0000
D 6 5.250000 194.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 49 87.000000 2446.9100 2446.9100
5870 4999.000000 123960.0300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5926 5091.750000 126619.6900 2446.9100
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 4 1.500000 55.5000 0.0000
S 1 1.000000 50.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 492 3553.750000 14196.5500 14196.5500
6378 4193.250000 153578.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6875 7749.500000 167880.2000 14196.5500
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 4438 6883.366234 75261.1000 75261.1000
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
5165 3289.158670 109070.2900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9603 10172.524904 184331.3900 75261.1000
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 38 101.500000 1242.7800 1242.7800
H 0 0.000000 0.0000 0.0000
T 2439 10240.000000 116142.3500 116438.3500
2223 6332.500000 236653.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4700 16674.000000 354038.3800 117681.1300