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
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 10170 13797.25000 510433.5000 36.9953
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 332 265.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7095 21325.50000 788585.0000 36.9785
Subtotal (Total Children Is Unduplicated) 13882 35388.25000 1299018.5000 36.7076
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 7 8.000000 388.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 31 40.750000 2037.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 7 14.000000 700.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 202 281.250000 14062.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 4.500000 337.5000 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 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 2 4.000000 222.0000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 16 19.000000 1054.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 78 150.500000 11287.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 163 298.327160 22374.5370 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 18 32.500000 2437.5000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 82 135.000000 10125.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 53 101.500000 7612.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 19 34.000000 2550.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 180 349.500000 19397.2500 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 403 655.500000 36352.5000 55.4577
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 62 121.000000 9075.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 99 154.230900 11567.3175 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 34 34.000000 2443.9200 71.8800
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1033 2464.558060 155978.1745 63.2885
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 9.000000 642.9600 71.4400
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 75 86.500000 4325.0000 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 470 320.250000 16012.5000 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 438 251.000000 12537.5000 49.9502
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 2050.750000 0.0000 0.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 79 257.500000 12875.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 103 196.250000 9812.5000 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 13 39.750000 2839.7400 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 21 56.000000 4000.6400 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 2 4.000000 285.7600 71.4400
PHY-97110-PT SESSION BY LICENSED PT 14 75.250000 5375.8600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 8 27.000000 1928.8800 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 1 2.000000 142.8800 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 2 2.500000 178.6000 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 33 99.500000 7108.2800 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 21 94.250000 6733.2200 71.4400
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) 2014 21885.25000 193205.1400 8.8281
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Total 59738.058060 1648201.8145 27.5905
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Number of Children (Unduplicated) With at Least One Service 14761
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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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 2.000000 100.0000 100.0000
280 224.750000 11572.8200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 281 226.750000 11672.8200 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 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 2851 1906.000000 51588.0500 0.0000
---------------------------------------------------------
Total 2851 1906.000000 51588.0500 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
2942 2172.250000 83225.5400 0.0000
Other 3 4.500000 279.0000 0.0000
---------------------------------------------------------
Total 2945 2176.750000 83504.5400 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 1 0.500000 18.5000 0.0000
P 1 0.500000 18.5000 18.5000
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
2630 2716.750000 110744.1700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2632 2717.750000 110781.1700 18.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 15 5.750000 212.7500 0.0000
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
2494 1320.750000 46943.7500 0.0000
Other 1 0.250000 9.2500 0.0000
---------------------------------------------------------
Total 2531 1525.750000 47416.7300 250.9800
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
3549 2086.750000 78561.2500 0.0000
Other 394 284.000000 10489.5000 0.0000
---------------------------------------------------------
Total 3943 2370.750000 89050.7500 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 14 11.750000 623.7500 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
6030 3169.058060 113771.8545 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6044 3180.808060 114395.6045 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 6788 6275.750000 238927.5800 238927.5800
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
3757 3603.000000 137068.9000 0.0000
Other 3 5.000000 259.0000 0.0000
---------------------------------------------------------
Total 10548 9883.750000 376255.4800 238927.5800
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 5 4.500000 166.5000 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
5323 4375.750000 177698.5000 0.0000
Other 13 21.750000 889.5000 0.0000
---------------------------------------------------------
Total 5341 4402.000000 178754.5000 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 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
21 48.000000 3181.4600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21 48.000000 3181.4600 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 4.000000 222.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 991 14573.500000 21464.4700 20319.0600
1974 1250.250000 37610.4800 36.2300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2967 15827.750000 59296.9500 20355.2900
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 7 6.000000 325.3200 0.0000
S 176 71.250000 2670.6900 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
6780 4302.750000 125360.4000 0.0000
Other 55 42.500000 1563.2500 0.0000
---------------------------------------------------------
Total 7018 4422.500000 129919.6600 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 2 1.750000 99.1900 0.0000
S 162 111.500000 1808.9400 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7441 4729.750000 153413.5300 0.0000
Other 154 114.500000 4236.5000 0.0000
---------------------------------------------------------
Total 7759 4957.500000 159558.1600 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 1 0.250000 9.2500 9.2500
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
4674 2831.500000 110096.9400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4675 2831.750000 110106.1900 9.2500
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
2588 3239.500000 121952.0000 0.0000
Other 25 20.750000 767.7500 0.0000
---------------------------------------------------------
Total 2613 3260.250000 122719.7500 0.0000