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
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 10369 14031.75000 519009.7500 36.9882
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 313 254.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18817 58000.25000 2144930.2500 36.9814
Subtotal (Total Children Is Unduplicated) 20183 72286.50000 2663940.0000 36.8525
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 7.000000 339.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 20 22.250000 1112.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 10.000000 500.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 187 291.250000 14562.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 38.000000 2850.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 53 96.000000 7161.0000 74.5938
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 37 56.000000 4200.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 15.500000 1162.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 15 27.500000 2012.5000 73.1818
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 12 23.000000 1725.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 24 47.500000 3533.2500 74.3842
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 28 51.500000 2858.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 77 139.500000 7642.2500 54.7832
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 486 941.500000 69555.0000 73.8768
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1196 2113.500000 157857.4200 74.6900
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 170 327.500000 24097.5000 73.5802
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 598 953.000000 71093.1900 74.5994
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 196 365.000000 27205.0000 74.5342
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 279 486.500000 36487.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 603 1125.000000 62305.5000 55.3827
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1464 2676.500000 147765.0000 55.2083
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 268 500.500000 37537.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 453 842.500000 63133.5000 74.9359
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 3 3.000000 91.0500 30.3500
MED-99202-OUTPATIENT VISIT, NEW, 20 MINS 1 1.000000 304.0000 304.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 67 67.000000 6500.3500 97.0201
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 5 5.000000 124.8500 24.9700
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 204.2000 51.0500
OCTH-97165GT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 3 3.000000 153.1500 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 102.1000 51.0500
PSTF-97164GT-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 4 4.000000 224.5900 56.1475
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
SCREEN-T1023-SCREENING 24 24.000000 1200.0000 50.0000
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 16.000000 837.1900 52.3244
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 459.4500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 3 3.000000 146.6500 48.8833
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
Subtotal (Total Children Is Unduplicated) 3589 11328.00000 758965.6900 66.9991
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 77 81.500000 4075.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 252 266.750000 13337.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 34.500000 862.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 161 164.000000 8187.5000 49.9238
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 483 387.000000 19350.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 26 13.250000 331.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 31 28.250000 1412.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 394 237.250000 11862.5000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 13 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 61 68.750000 3437.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 418 216.000000 10800.0000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 8 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 93 89.500000 4475.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 440 241.250000 12062.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 22 20.750000 518.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 735 1528.250000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 393 1554.000000 77675.0000 49.9839
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 563 1702.750000 85137.5000 50.0000
INTR-T1013-INTERPRETER 100 373.750000 18687.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 440 1620.000000 16200.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 58 174.500000 12260.5200 70.2609
OCCT-97530GT-OT SESSION BY LICENSED OT 84 232.500000 16645.5200 71.5936
OCCT-97530TL-OT SESSION BY LICENSED OT 32 73.500000 5250.8400 71.4400
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2021 ending 12/31/2021 Date of Report:02/04/2022 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-97530TLGT-OT SESSION BY LICENSED OT 93 281.750000 20128.2200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 69 221.750000 15841.8200 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 42 128.750000 9197.9000 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 77 225.250000 16091.8600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 52 151.750000 10841.0200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 220 864.250000 59113.3500 68.3984
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 125 496.250000 35311.6600 71.1570
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 98 358.250000 25593.3800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 120 494.000000 35104.8400 71.0624
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.7600 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 98 107.500000 3977.5000 37.0000
TRAV-TRAVS-Travel by mile 224 15286.00000 6801.5000 0.4449
Subtotal (Total Children Is Unduplicated) 2504 27732.50000 560775.1900 20.2209
-----------------------------------------------------------------------------------------------------------------------
Total 111347.000000 3983680.8800 35.7772
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20781
-----------------------------------------------------------------------------------------------------------------------
Center 01
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.500000 18.5000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 713 563.000000 31692.4700 0.0000
H 157 189.750000 12161.3100 0.0000
T 0 0.000000 0.0000 0.0000
402 291.750000 15029.7800 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 1274 1045.250000 58911.3100 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 3962 2375.500000 89768.1300 0.0000
---------------------------------------------------------
Total 3962 2375.500000 89768.1300 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 35.000000 1295.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1725 1598.500000 80643.9000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 2.000000 100.0000 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
4301 3079.000000 132179.8200 0.0000
Other 1418 935.250000 38125.0300 0.0000
---------------------------------------------------------
Total 7513 5649.750000 252343.7500 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 13 24.500000 906.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2613 4335.500000 172628.5000 0.0000
P 737 1234.250000 48738.7500 48470.4700
D 9 9.000000 333.0000 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
2869 3233.000000 146107.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6241 8836.250000 368714.0000 48470.4700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 9.000000 333.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2348 1541.000000 57017.0000 24341.3800
P 9 14.250000 152.5000 152.5000
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
2045 1116.000000 40533.5000 0.0000
Other 30 23.000000 851.0000 0.0000
---------------------------------------------------------
Total 4444 2703.750000 98905.5000 24493.8800
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
9080 6202.500000 260912.7500 0.0000
Other 193 142.000000 5254.0000 0.0000
---------------------------------------------------------
Total 9273 6344.500000 266166.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 375 302.500000 11944.5000 0.0000
P 2477 2083.204900 88663.8675 88395.8600
D 23 24.750000 1256.7500 0.0000
S 3 4.500000 318.5000 0.0000
H 5 10.000000 750.0000 0.0000
T 0 0.000000 0.0000 0.0000
6705 3727.795100 140196.1325 0.0000
Other 308 178.250000 6886.0000 0.0000
---------------------------------------------------------
Total 9900 6333.000000 250089.7500 88395.8600
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 368 401.000000 16178.5700 166.5000
P 14084 13694.000000 530700.0700 531271.8820
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 183 304.500000 17295.7500 0.0000
T 62 50.250000 1892.5000 2109.0000
282 283.750000 13106.0800 0.0000
Other 12 18.250000 823.2500 0.0000
---------------------------------------------------------
Total 14991 14751.750000 579996.2200 533547.3820
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 73 55.750000 2062.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 8661 7459.250000 308249.7500 0.0000
P 70 93.750000 5577.9100 107.1600
D 28 21.500000 956.2500 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
5035 4949.000000 217413.2900 0.0000
Other 405 302.500000 11843.2500 0.0000
---------------------------------------------------------
Total 14272 12881.750000 546103.2000 107.1600
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 23 30.000000 2045.2500 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
131 228.000000 14233.2700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 154 258.000000 16278.5200 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 601 616.250000 27850.7200 252.1000
P 1879 2044.750000 96888.6600 99422.4700
D 204 221.750000 11246.2500 130.0000
S 19 23.250000 1125.3200 231.7500
H 161 205.000000 13001.3200 35.0000
T 1296 16370.500000 40157.1100 33937.0200
2251 1428.750000 44176.2600 0.0000
Other 18 11.250000 416.2500 0.0000
---------------------------------------------------------
Total 6429 20921.500000 234861.8900 134008.3400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 34 31.750000 1588.0300 0.0000
U 0 0.000000 0.0000 0.0000
B 1937 1766.250000 87334.6900 1055.0000
P 1312 1254.500000 59858.8900 59840.3900
D 61 64.250000 4090.2200 0.0000
S 174 143.750000 8337.0600 1646.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7037 4516.000000 161150.6800 0.0000
Other 242 204.000000 11670.3100 0.0000
---------------------------------------------------------
Total 10797 7980.500000 334029.8800 62541.8900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 4.250000 157.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 3179 2678.000000 123228.4500 1959.2500
P 1645 1439.500000 66853.5600 66734.5900
D 32 31.500000 2035.9600 0.0000
S 24 18.000000 687.1900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6763 4624.750000 187636.1000 0.0000
Other 252 191.500000 9293.2200 0.0000
---------------------------------------------------------
Total 11898 8987.500000 389891.7300 68693.8400
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.000000 150.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2731 2180.500000 90573.4600 0.0000
P 4 7.750000 286.7500 286.7500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 91 124.000000 8866.9800 0.0000
T 0 0.000000 0.0000 0.0000
3945 2320.000000 89622.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6772 4634.250000 189499.8300 286.7500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 725 955.500000 40454.7500 0.0000
P 2075 2776.750000 114213.2500 114562.9400
D 0 0.000000 0.0000 0.0000
S 1 1.500000 112.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 68 161.500000 6271.4200 2577.9500
2448 3746.250000 146985.2500 0.0000
Other 2 1.750000 64.7500 0.0000
---------------------------------------------------------
Total 5320 7643.750000 308120.4200 117140.8900