CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 Page: 1
List order: No List
Eligibility Filter:Not Part C
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Service Coordination,Class #01
CASE-CASE-NON-TCM CASE MANAGEMENT 826 983.500000 36380.2500 36.9906
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 62 50.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 1516 6274.500000 231788.7500 36.9414
Subtotal (Total Children Is Unduplicated) 1552 7308.000000 268169.0000 36.6953
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Screening, Eval, and Assessment,Class #02
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 27 47.500000 3533.2500 74.3842
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 6 10.500000 787.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 15 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 3 5.000000 375.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 8 13.500000 1012.5000 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 9 14.500000 1087.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 18 33.000000 1831.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 35 60.500000 3357.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 144 260.500000 18790.0000 72.1305
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 511 852.500000 63567.1500 74.5656
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 33 57.500000 4087.5000 71.0870
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 233 366.500000 27237.5000 74.3179
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 57 99.000000 7425.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 191 320.500000 23937.5000 74.6880
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 205 360.000000 19579.1300 54.3865
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 648 1059.000000 58457.0300 55.2002
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 74 128.000000 9600.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 148 251.500000 18783.2500 74.6849
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 2 2.000000 60.7000 30.3500
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 17 17.000000 2085.5900 122.6818
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1214 4013.000000 269658.9000 67.1963
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EI Services,Class #03
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 1 0.500000 25.0000 50.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.500000 75.0000 50.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 17 26.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 27.000000 1350.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 7.000000 350.0000 50.0000
INTR-T1013-INTERPRETER 25 73.750000 3687.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 80 170.000000 1700.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 3 12.000000 857.2800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 13.500000 964.4400 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.4400 71.4400
TRAV-TRAVS-Travel by mile 54 1644.000000 731.4300 0.4449
Subtotal (Total Children Is Unduplicated) 164 1977.250000 9862.0900 4.9878
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Total 13298.250000 547689.9900 41.1851
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Number of Children (Unduplicated) With at Least One Service 1680
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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 35 113.750000 2562.3400 2562.3400
D 10 26.500000 744.5700 0.0000
S 45 54.000000 3502.2500 0.0000
H 9 13.000000 887.2500 0.0000
T 9 14.500000 725.0000 725.0000
24 32.750000 1956.0000 0.0000
Other 22 33.000000 2124.0000 0.0000
---------------------------------------------------------
Total 154 287.500000 12501.4100 3287.3400
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 30 737.750000 1832.7100 1832.7100
3 58.000000 174.9200 0.0000
Other 555 358.750000 15147.7500 0.0000
---------------------------------------------------------
Total 588 1154.500000 17155.3800 1832.7100
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 139 207.500000 10990.5000 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 2 11.000000 550.0000 550.0000
T 0 0.000000 0.0000 0.0000
212 263.500000 14203.5000 0.0000
Other 80 105.000000 5096.5000 0.0000
---------------------------------------------------------
Total 434 589.000000 30914.5000 550.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 131 209.750000 9015.0000 0.0000
P 56 85.250000 3692.5000 3692.8900
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
232 282.500000 14854.7900 0.0000
Other 4 13.500000 964.4400 0.0000
---------------------------------------------------------
Total 423 591.000000 28526.7300 3692.8900
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 197 194.250000 7187.2500 2747.2500
P 138 344.000000 8828.2700 8828.2700
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
377 348.750000 10776.8800 278.1300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 712 887.000000 26792.4000 11853.6500
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 40 46.000000 1397.7500 1397.7500
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
1207 1271.750000 60534.2500 0.0000
Other 38 32.000000 1184.0000 0.0000
---------------------------------------------------------
Total 1285 1349.750000 63116.0000 1397.7500
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 8 9.500000 464.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 24 33.750000 1437.7500 0.0000
P 284 355.919100 15712.4325 15712.4300
D 1 2.000000 150.0000 0.0000
S 1 2.000000 150.0000 0.0000
H 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
473 369.830900 13763.0675 0.0000
Other 21 20.750000 767.7500 0.0000
---------------------------------------------------------
Total 813 795.750000 32595.5000 15712.4300
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9 14.250000 789.2500 0.0000
P 651 939.000000 42277.2500 42343.2900
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 150 220.500000 12428.2500 0.0000
T 2 4.000000 300.0000 300.0000
79 135.000000 8453.0000 0.0000
Other 39 68.500000 4722.2500 0.0000
---------------------------------------------------------
Total 930 1381.250000 68970.0000 42643.2900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 368 416.500000 18893.7500 0.0000
P 9 15.500000 914.5000 1672.4000
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
358 473.000000 23705.7500 0.0000
Other 30 30.250000 1422.2500 0.0000
---------------------------------------------------------
Total 766 935.750000 44954.7500 1672.4000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 5 5.500000 393.0000 0.0000
P 25 35.500000 825.3800 825.3800
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
25 30.500000 1844.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 55 71.500000 3063.0200 825.3800
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 27 41.250000 1830.2500 0.0000
P 119 201.750000 10165.0900 10045.3000
D 11 22.000000 1260.0000 0.0000
S 2 4.000000 261.0000 0.0000
H 18 36.000000 2505.0000 0.0000
T 67 625.000000 3625.4300 3223.4300
157 211.000000 8785.7500 53.6100
Other 1 0.500000 18.5000 0.0000
---------------------------------------------------------
Total 402 1141.500000 28451.0200 13322.3400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 114 126.250000 6023.7500 0.0000
P 128 147.000000 6621.7500 6621.7500
D 0 0.000000 0.0000 0.0000
S 4 3.000000 168.0000 18.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
328 277.500000 12186.5000 0.0000
Other 7 6.250000 231.2500 0.0000
---------------------------------------------------------
Total 581 560.000000 25231.2500 6640.2500
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 297 334.750000 15447.5000 150.0000
P 109 140.750000 6645.7500 6645.7500
D 1 2.000000 150.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 8 14.100000 938.5000 938.5000
387 403.150000 18763.5000 0.0000
Other 9 5.750000 249.7500 0.0000
---------------------------------------------------------
Total 811 900.500000 42195.0000 7734.2500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 475 596.500000 28181.5000 0.0000
P 17 33.600000 2325.0000 2325.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 11 22.000000 1650.0000 0.0000
T 0 0.000000 0.0000 0.0000
644 601.400000 30363.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1147 1253.500000 62519.5000 2325.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 55 96.250000 4619.5000 0.0000
P 233 453.000000 20193.2500 20356.2100
D 2 2.000000 130.5000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 31 84.250000 3071.0300 1927.2500
457 756.000000 32384.0000 0.0000
Other 4 8.250000 305.2500 0.0000
---------------------------------------------------------
Total 782 1399.750000 60703.5300 22283.4600