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
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 10368 14030.75000 518972.7500 36.9882
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 313 254.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 6884 21226.00000 785130.7500 36.9891
Subtotal (Total Children Is Unduplicated) 14066 35511.25000 1304103.5000 36.7237
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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 178 279.250000 13962.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 8 11.000000 825.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.500000 112.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 5 9.500000 712.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 3 6.000000 333.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 21 35.500000 1970.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 55 103.798600 7784.8950 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 175 308.996500 23145.4875 74.9053
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 33.500000 2512.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 109 172.500000 12937.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 23 42.000000 3150.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 29 52.500000 3937.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 149 276.500000 15345.7500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 367 610.000000 33855.0000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 65 122.000000 9150.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 114 181.000000 13555.5000 74.8923
MED-99201-OUTPATIENT VISIT, NEW, 10 MINS 1 1.000000 30.3500 30.3500
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 32 32.000000 2077.0500 64.9078
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 2 2.000000 46.8400 23.4200
Subtotal (Total Children Is Unduplicated) 968 2331.795100 148296.1225 63.5974
-----------------------------------------------------------------------------------------------------------------------
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 1526.000000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 78 216.500000 10825.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 105 282.000000 14100.0000 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 10 41.500000 2964.7600 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 23 42.250000 3018.3400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 1 1.000000 71.4400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 51.000000 3643.4400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 12 30.750000 2196.7800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 4 7.750000 553.6600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 125.000000 8930.0000 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 31 141.000000 10073.0400 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 5.000000 357.2000 71.4400
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) 1984 21714.75000 193430.5400 8.9078
-----------------------------------------------------------------------------------------------------------------------
Total 59557.795100 1645830.1625 27.6342
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 14799
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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 0 0.000000 0.0000 0.0000
S 1 0.250000 9.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
377 264.250000 13148.0900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 378 264.500000 13157.3400 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 2504 1376.750000 47283.3800 0.0000
---------------------------------------------------------
Total 2504 1376.750000 47283.3800 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
3809 2472.500000 88314.8500 0.0000
Other 4 5.000000 367.8800 0.0000
---------------------------------------------------------
Total 3813 2477.500000 88682.7300 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 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
2612 2861.250000 118912.7400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2612 2861.250000 118912.7400 0.0000
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 9 14.250000 152.5000 152.5000
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
2019 1104.000000 40089.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2028 1118.250000 40242.0000 152.5000
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
4245 2298.750000 86420.5000 0.0000
Other 192 141.250000 5226.2500 0.0000
---------------------------------------------------------
Total 4437 2440.000000 91646.7500 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 0 0.000000 0.0000 0.0000
D 18 16.250000 677.2500 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
6645 3627.545100 133066.8825 0.0000
Other 8 5.500000 194.2500 0.0000
---------------------------------------------------------
Total 6671 3649.295100 133938.3825 0.0000
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 10267 9711.250000 372335.2500 372335.2500
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 56 42.750000 1581.7500 1581.7500
0 0.000000 0.0000 0.0000
Other 3 6.000000 333.0000 0.0000
---------------------------------------------------------
Total 10326 9760.000000 374250.0000 373917.0000
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
4717 4291.000000 172218.0000 0.0000
Other 2 4.000000 261.0000 0.0000
---------------------------------------------------------
Total 4719 4295.000000 172479.0000 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 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
44 84.500000 5230.7900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 44 84.500000 5230.7900 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 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 2 3.000000 161.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1039 16071.750000 23612.7700 21968.3700
2220 1389.500000 42549.2500 0.0000
Other 3 1.000000 37.0000 0.0000
---------------------------------------------------------
Total 3264 17465.250000 66360.0200 21968.3700
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 0 0.000000 0.0000 0.0000
D 15 18.000000 779.0000 0.0000
S 18 13.750000 618.9400 92.5000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6308 3790.000000 117409.4700 0.0000
Other 24 18.250000 675.2500 0.0000
---------------------------------------------------------
Total 6365 3840.000000 119482.6600 92.5000
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 1 1.750000 64.7500 64.7500
D 18 17.750000 1225.1800 0.0000
S 14 9.500000 325.2500 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6296 4121.000000 154512.9400 0.0000
Other 77 47.000000 1739.0000 0.0000
---------------------------------------------------------
Total 6406 4197.000000 157867.1200 64.7500
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
3776 2170.500000 81657.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3776 2170.500000 81657.7500 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 0 0.000000 0.0000 0.0000
2335 3558.000000 134639.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2335 3558.000000 134639.5000 0.0000