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
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 11014 14722.75000 544484.0000 36.9825
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 304 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19507 67369.00000 2491438.0000 36.9820
Subtotal (Total Children Is Unduplicated) 20742 82383.50000 3035922.0000 36.8511
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 43 54.500000 2725.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 7.000000 350.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 152 229.250000 11462.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 24 46.500000 3487.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 60 99.500000 7337.2500 73.7412
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 28 42.500000 3150.0000 74.1176
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 9.500000 712.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 19.500000 1462.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 10 19.500000 1423.5000 73.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 31 54.000000 4020.7500 74.4583
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 38 67.500000 3746.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 82 141.000000 7825.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 502 962.500000 71287.5000 74.0649
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1434 2538.500000 189552.0900 74.6709
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 217 403.000000 29885.0000 74.1563
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 535 908.500000 67538.5400 74.3407
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 244 462.500000 34517.5000 74.6324
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 337 605.000000 45365.0000 74.9835
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 635 1226.000000 67646.7600 55.1768
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1589 2838.000000 156938.3000 55.2989
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 315 611.000000 45786.0000 74.9362
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 445 756.000000 56700.0000 75.0000
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 8 9.000000 619.4500 68.8278
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 60 60.000000 7210.9500 120.1825
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 3 3.000000 239.8400 79.9467
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 8.5500 8.5500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97161GT-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161TL-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 29 29.000000 1450.0000 50.0000
SPCH-92522GT-EVAL OF SPCH SOUND PROD 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 13 14.000000 714.7000 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 10 11.000000 561.5500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 204.2000 51.0500
Subtotal (Total Children Is Unduplicated) 4001 12276.25000 826495.3800 67.3247
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 1 1.000000 59.9900 59.9900
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 83 89.000000 4450.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 232 254.500000 12725.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 30.250000 756.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 157 163.000000 8150.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 523 415.250000 20762.5000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 24 26.500000 662.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 40 27.750000 1387.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 472 283.500000 14175.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 9 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 48 54.500000 2725.0000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 367 169.000000 8450.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 1 1.000000 25.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 83 89.250000 4462.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 396 249.750000 12487.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 35 37.750000 943.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 617 1027.500000 0.0000 0.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 2.000000 50.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 385 1477.250000 73757.5000 49.9289
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 562 1910.000000 95500.0000 50.0000
INTR-T1013-INTERPRETER 94 277.000000 13850.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 360 1290.000000 12850.0000 9.9612
OCCT-97530-OT SESSION BY LICENSED OT 56 122.750000 8769.2600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 89 274.500000 19482.7800 70.9755
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
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
OCCT-97530TL-OT SESSION BY LICENSED OT 33 77.750000 5536.6000 71.2103
OCCT-97530TLGT-OT SESSION BY LICENSED OT 96 285.250000 20378.2600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 70 166.000000 11859.0400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 46 179.250000 12805.6200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 0.500000 28.5800 57.1600
PHY-97110TL-PT SESSION BY LICENSED PT 45 125.000000 8930.0000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 72 222.000000 15859.6800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 183 722.500000 51325.9600 71.0394
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 141 514.250000 36380.0800 70.7440
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 97 348.250000 24878.9800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 155 566.250000 40262.8000 71.1043
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.000000 13.8800 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 103 105.750000 3912.7500 37.0000
TRAV-TRAVS-Travel by mile 179 11478.00000 5107.0800 0.4449
Subtotal (Total Children Is Unduplicated) 2571 23070.75000 553911.3400 24.0092
-----------------------------------------------------------------------------------------------------------------------
Total 117730.500000 4416328.7200 37.5122
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21558
-----------------------------------------------------------------------------------------------------------------------
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 2 2.000000 100.0000 0.0000
S 1016 911.000000 55837.4900 0.0000
H 191 222.000000 13964.9900 0.0000
T 0 0.000000 0.0000 0.0000
688 666.500000 37854.2300 0.0000
Other 6 4.750000 175.7500 0.0000
---------------------------------------------------------
Total 1903 1806.250000 107932.4600 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 59.9900 0.0000
0 0.000000 0.0000 0.0000
Other 3951 2365.500000 95547.0200 0.0000
---------------------------------------------------------
Total 3952 2366.500000 95607.0100 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 0.750000 27.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 2547 2092.500000 100760.4700 0.0000
P 1 1.000000 71.4400 71.4400
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
3956 2967.750000 133251.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6507 5062.000000 234111.5200 71.4400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2086 3367.000000 131550.5000 0.0000
P 831 1470.750000 57923.0000 57624.3200
D 7 10.000000 370.0000 0.0000
S 2 3.750000 138.7500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3149 7061.000000 285445.4900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6075 11912.500000 475427.7400 57624.3200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2643 1800.750000 68077.4600 33295.5700
P 28 43.250000 2094.7800 2094.7800
D 4 3.500000 232.8200 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
2237 1328.250000 48590.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4912 3175.750000 118995.3100 35390.3500
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
11675 7790.250000 318484.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11675 7790.250000 318484.0000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 63 45.000000 1665.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 850 679.750000 28881.7500 0.0000
P 2641 2345.500000 100678.7500 100449.3500
D 28 18.250000 827.2500 0.0000
S 1 0.250000 9.2500 0.0000
H 40 80.000000 6000.0000 0.0000
T 0 0.000000 0.0000 0.0000
6918 3789.000000 140972.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10541 6957.750000 279034.5000 100449.3500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 1.250000 46.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 748 764.250000 29974.6300 0.0000
P 10247 9828.500000 382296.5600 382602.1400
D 2 3.250000 120.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 171 286.500000 16015.7500 0.0000
T 7 7.000000 263.5500 98.0500
3610 3355.500000 131052.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 14786 14246.250000 559769.4600 382700.1900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 12.000000 444.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 8791 7896.500000 334130.7500 0.0000
P 5 9.000000 647.1000 294.8000
D 180 165.750000 7922.0000 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
4798 4588.250000 208449.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13787 12671.500000 551593.6000 294.8000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 19 22.000000 1445.2500 0.0000
P 2 10.000000 300.0000 300.0000
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
920 866.250000 38754.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 941 898.250000 40499.7100 300.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 608 658.500000 32451.0300 0.0000
P 2327 2337.250000 103495.6100 101170.5100
D 138 157.750000 8249.5000 130.0000
S 138 124.500000 5669.3400 243.5500
H 180 235.500000 15379.4000 328.9600
T 1132 12668.750000 34597.1300 28802.5400
2754 1714.250000 58414.6300 9.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 7279 17897.250000 258284.3900 130684.5600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 31.000000 1550.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2275 2031.250000 97916.9400 74.0000
P 1656 1459.250000 69472.9100 69097.2100
D 73 74.250000 4923.6700 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
6442 4229.750000 169791.0400 0.0000
Other 92 86.250000 5171.9900 0.0000
---------------------------------------------------------
Total 10569 7911.750000 348826.5500 69171.2100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2824 2409.500000 106940.2600 0.0000
P 2447 2031.500000 89889.8900 89818.4520
D 19 16.000000 840.8800 0.0000
S 1 1.000000 50.0000 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
6751 4329.000000 182280.8200 0.0000
Other 113 103.500000 6483.9200 0.0000
---------------------------------------------------------
Total 12156 8891.500000 386557.2100 89818.4520
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3706 2867.000000 117935.7900 0.0000
P 2 0.500000 18.5000 18.5000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 89 123.548000 8752.4600 0.0000
T 0 0.000000 0.0000 0.0000
4427 2575.202000 102327.1800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8224 5566.250000 229033.9300 18.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 11.000000 407.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2887 3755.500000 151364.7500 0.0000
P 217 265.250000 11387.0000 11174.7500
D 6 6.500000 448.5000 0.0000
S 1 0.500000 18.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 3 13.000000 92.5000 388.5000
2369 6525.000000 248453.0800 28.5800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5487 10576.750000 412171.3300 11591.8300