CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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 10172 13799.00000 510498.2500 36.9953
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 332 265.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18583 57737.75000 2134634.3500 36.9712
Subtotal (Total Children Is Unduplicated) 19815 71802.25000 2645132.6000 36.8391
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 8.000000 388.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 35 48.750000 2437.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 10 20.000000 1000.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 204 285.250000 14262.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 20 38.500000 2887.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 58 103.500000 7762.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 10 19.000000 1425.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 46 70.000000 5250.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 5 10.000000 750.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 15 27.500000 2062.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 8 16.500000 1237.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 21 35.500000 2662.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 25 47.500000 2636.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 77 131.500000 7248.2500 55.1198
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 548 1072.000000 80168.1500 74.7837
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1137 2069.000000 154861.0000 74.8482
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 135 252.000000 18560.0000 73.6508
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 650 1067.500000 80022.5000 74.9625
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 220 419.000000 31425.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 309 557.000000 41314.9500 74.1741
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 595 1162.000000 64491.0000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1627 3017.000000 167053.9500 55.3709
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 263 512.500000 38437.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 477 832.000000 62205.0000 74.7656
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 67 67.000000 8065.6400 120.3827
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.1700 31.1700
OCTH-97165-OT EVAL LOW COMPLEXITY 3 3.000000 153.1500 51.0500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 31.0500 31.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 2 3.000000 153.1500 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97162TL-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 17 18.000000 850.0000 47.2222
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 18.000000 918.9000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 337.3500 48.1929
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 3808 11951.50000 801702.0600 67.0796
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 12.000000 857.2800 71.4400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 76 87.500000 4375.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 266 273.000000 13650.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 23 24.500000 612.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 159 171.250000 8562.5000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 470 320.500000 16025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 10 10.250000 256.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 70 61.500000 3037.5000 49.3902
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 440 253.000000 12637.5000 49.9506
CONOP-CONOP-CONSULT, OT, PHONE 8 6.000000 150.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 62 92.750000 4637.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 470 233.500000 11625.0000 49.7859
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 108 102.500000 5125.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 458 254.250000 12712.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 11.750000 293.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 817 2053.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 404 1638.000000 81735.0000 49.8993
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 511 1469.000000 73450.0000 50.0000
INTR-T1013-INTERPRETER 79 298.750000 14887.5000 49.8326
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 562 2295.000000 22950.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 171.000000 12216.2400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 71 187.000000 13319.2800 71.2261
OCCT-97530TL-OT SESSION BY LICENSED OT 60 173.750000 12412.7000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 104 329.000000 23503.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 77 302.250000 21628.4600 71.5582
PHY-97110GT-PT SESSION BY LICENSED PT 44 120.500000 8608.5200 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 86 299.000000 21360.5600 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 72 165.750000 11841.1800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 208 811.000000 56162.4400 69.2509
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 118 430.250000 30449.5000 70.7716
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 112 377.750000 26986.4200 71.4399
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 117 435.250000 31094.2600 71.4400
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 3 4.000000 55.5200 13.8800
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 85 94.750000 3505.7500 37.0000
TRAV-TRAVS-Travel by mile 232 14384.00000 6400.0700 0.4449
Subtotal (Total Children Is Unduplicated) 2435 27954.50000 567174.4400 20.2892
-----------------------------------------------------------------------------------------------------------------------
Total 111708.250000 4014009.1000 35.9330
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20454
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 50.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 575 499.500000 27901.9200 0.0000
H 119 131.750000 8539.2600 0.0000
T 1 2.000000 100.0000 100.0000
309 263.500000 14181.9700 0.0000
Other 3 3.250000 120.2500 0.0000
---------------------------------------------------------
Total 1008 901.000000 50893.4000 100.0000
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 1 0.250000 9.2500 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 4248 2851.750000 91592.3000 0.0000
---------------------------------------------------------
Total 4249 2852.000000 91601.5500 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 3 2.500000 126.9400 0.0000
U 0 0.000000 0.0000 0.0000
B 1890 1603.750000 79072.2700 0.0000
P 81 76.250000 3988.3400 3988.3400
D 5 6.250000 373.5000 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
3409 2766.250000 126240.6200 0.0000
Other 111 123.000000 5156.5000 0.0000
---------------------------------------------------------
Total 5499 4578.000000 214958.1700 3988.3400
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 13.000000 858.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2700 4264.000000 169388.9400 0.0000
P 644 1122.750000 41569.5000 41569.5000
D 31 36.750000 1359.7500 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
2972 3141.500000 140515.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6358 8578.000000 353692.0600 41569.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 53 34.500000 1276.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2206 1404.500000 51966.5000 14420.7500
P 21 199.000000 250.9800 250.9800
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
2510 1329.000000 47249.0000 0.0000
Other 70 52.250000 1933.2500 0.0000
---------------------------------------------------------
Total 4860 3019.250000 102676.2300 14671.7300
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
8304 6193.250000 267215.0000 0.0000
Other 396 285.000000 10526.5000 0.0000
---------------------------------------------------------
Total 8700 6478.250000 277741.5000 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 90 78.500000 2904.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 906 840.250000 39351.0000 0.0000
P 1472 1268.441940 54071.3955 53967.5400
D 17 17.750000 1073.7500 0.0000
S 1 0.250000 9.2500 0.0000
H 7 14.000000 1050.0000 0.0000
T 1 0.250000 9.2500 0.0000
6068 3232.808060 118334.6045 0.0000
Other 296 149.000000 5589.0000 0.0000
---------------------------------------------------------
Total 8858 5601.250000 222392.7500 53967.5400
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 10 8.500000 314.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 1055 1109.250000 44273.7600 37.0000
P 10029 9579.000000 370817.7900 371080.8950
D 11 11.000000 550.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 168 274.500000 16089.0000 0.0000
T 12 13.750000 697.7500 729.5000
3904 3823.750000 149976.4800 225.0000
Other 44 56.250000 2155.2500 0.0000
---------------------------------------------------------
Total 15233 14876.000000 584874.5300 372072.3950
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 66 72.500000 3365.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 8403 7226.250000 302447.2500 0.0000
P 70 61.000000 2294.0000 0.0000
D 24 22.000000 890.0000 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
5894 5231.000000 231699.2500 0.0000
Other 1157 923.750000 36811.0000 0.0000
---------------------------------------------------------
Total 15614 13536.500000 577507.0000 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
48 100.250000 6632.1900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 48 100.250000 6632.1900 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 43.000000 2416.5200 0.0000
U 0 0.000000 0.0000 0.0000
B 563 615.000000 30038.0800 37.0000
P 1590 1664.250000 75238.6800 73914.3900
D 171 189.250000 9710.5000 0.0000
S 29 35.250000 1540.1300 59.2500
H 90 112.750000 6981.7500 9.2500
T 1195 14799.250000 34506.1200 29131.1100
2130 1463.750000 51244.2500 1306.2300
Other 4 2.750000 101.7500 0.0000
---------------------------------------------------------
Total 5814 18925.250000 211777.7800 104457.2300
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 36 35.000000 1415.8800 0.0000
U 0 0.000000 0.0000 0.0000
B 1505 1385.750000 70465.6100 9.2500
P 658 621.500000 30270.2700 30270.3100
D 35 32.750000 2219.1200 0.0000
S 270 139.000000 5672.6400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
8442 5913.250000 216327.5100 0.0000
Other 362 274.250000 12612.8300 0.0000
---------------------------------------------------------
Total 11308 8401.500000 338983.8600 30279.5600
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 108 142.250000 8652.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2596 2242.000000 101147.4000 0.0000
P 849 793.250000 36881.2900 36881.2900
D 10 8.500000 512.5300 0.0000
S 216 173.000000 6245.8000 0.0000
H 1 1.000000 71.4400 0.0000
T 0 0.000000 0.0000 0.0000
9615 6779.250000 259759.0100 0.0000
Other 308 228.500000 9360.3000 155.6900
---------------------------------------------------------
Total 13703 10367.750000 422629.7700 37036.9800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2723 2433.750000 104601.1500 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 72 114.000000 8143.2000 0.0000
T 0 0.000000 0.0000 0.0000
4954 3112.000000 124083.1100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7751 5660.250000 236845.9600 18.5000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 850 1302.500000 53915.7500 0.0000
P 1685 2218.750000 93755.5000 102202.4700
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 5 4.250000 233.2500 59.6000
3254 4282.750000 171982.1000 0.0000
Other 27 24.750000 915.7500 0.0000
---------------------------------------------------------
Total 5821 7833.000000 320802.3500 102262.0700