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
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 11013 14718.50000 544326.7500 36.9825
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 304 291.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6741 28228.50000 1043725.0000 36.9742
Subtotal (Total Children Is Unduplicated) 14429 43238.75000 1588051.7500 36.7275
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 5 6.000000 291.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 41 49.389200 2469.4600 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 2 3.000000 150.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 146 220.139200 11006.9600 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.000000 225.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 12 19.336800 1450.2600 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 6 10.500000 787.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 4 7.000000 525.0000 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 4 7.000000 388.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 30 48.000000 2664.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 68 127.000000 9525.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 193 330.613867 24796.0400 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 35 61.500000 4612.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 99 160.500000 12037.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 36 66.500000 4987.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 43 73.000000 5475.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 167 322.000000 17871.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 384 625.000000 34659.7500 55.4556
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 90 179.000000 13386.0000 74.7821
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 102 165.500000 12412.5000 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
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 2 2.000000 100.0000 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) 1070 2546.979067 163619.5900 64.2407
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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 1026.500000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 65 208.500000 10425.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 101 284.750000 14237.5000 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 7 17.000000 1214.4800 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 23 57.250000 4089.9400 71.4400
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 13 36.000000 2571.8400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 10 34.000000 2428.9600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 31 89.250000 6376.0200 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 42 148.500000 10608.8400 71.4400
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) 2051 16952.25000 180169.9200 10.6281
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Total 62737.979067 1931841.2600 30.7922
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Number of Children (Unduplicated) With at Least One Service 15256
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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 1 1.000000 50.0000 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
644 619.750000 34679.1700 0.0000
Other 5 4.500000 166.5000 0.0000
---------------------------------------------------------
Total 650 625.250000 34895.6700 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 2622 1404.250000 54205.7700 0.0000
---------------------------------------------------------
Total 2623 1405.250000 54265.7600 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
3440 2318.750000 86130.6600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3440 2318.750000 86130.6600 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 1 1.000000 55.5000 83.2500
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
2750 6502.000000 251135.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2751 6503.000000 251191.4700 83.2500
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 28 43.250000 2094.7800 2094.7800
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
2231 1326.250000 48516.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2259 1369.500000 50611.0300 2094.7800
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
5585 3095.750000 115704.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5585 3095.750000 115704.2500 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 4 10.000000 300.0000 300.0000
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
6836 3652.750000 132192.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6882 3707.250000 135278.7500 300.0000
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 6835 6228.000000 236351.6000 236351.6000
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
3529 3224.500000 123130.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10364 9452.500000 359481.9500 236351.6000
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 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
4438 3806.750000 154741.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4438 3806.750000 154741.5000 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 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
588 470.250000 18447.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 590 480.250000 18747.4600 300.0000
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 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 920 12410.500000 21236.9300 19234.5600
2671 1625.000000 54082.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3605 14043.000000 75643.4300 19308.5600
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 0 0.000000 0.0000 0.0000
5660 3408.000000 119161.3700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5667 3413.750000 119374.1200 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 4 1.500000 55.5000 0.0000
S 1 1.000000 50.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6200 3759.250000 147129.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6205 3761.750000 147235.2400 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
4281 2410.229067 91812.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4281 2410.229067 91812.7200 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 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 3 13.000000 92.5000 388.5000
2222 6332.000000 236634.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2225 6345.000000 236727.2500 388.5000