CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 11327 14997.50000 554768.7500 36.9907
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 522 483.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 21024 66009.50000 2441820.4900 36.9920
Subtotal (Total Children Is Unduplicated) 22468 81490.50000 2996589.2400 36.7723
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 19 21.000000 1018.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 22 30.750000 1537.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 4 8.000000 400.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 211 361.000000 18050.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 42 80.000000 5887.5000 73.5938
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 63 114.000000 8550.0000 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 41 66.000000 4950.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 18.500000 1387.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 22.000000 1650.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 22 41.000000 3075.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 12 21.000000 1575.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 39 73.500000 3892.2500 52.9558
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 72 125.500000 6965.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 708 1347.000000 100432.5000 74.5601
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1146 2098.499999 157179.5000 74.9009
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 234 438.000000 32320.0000 73.7900
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 703 1157.500000 86672.7100 74.8792
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 241 441.500000 32997.5000 74.7395
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 290 508.500000 38098.5000 74.9233
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 719 1372.000000 75750.0000 55.2114
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1714 3220.500000 178359.5000 55.3825
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 326 593.500000 44512.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 455 796.500000 59737.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 69 69.000000 7048.8000 102.1565
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 193.0000 193.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 2 5.000000 255.2500 51.0500
OCTH-97165TLGT-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 62.1000 31.0500
OCTH-97166TL-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.1000 51.0500
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 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 204.2000 51.0500
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
SCREEN-T1023-SCREENING 49 49.000000 2450.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 2 2.000000 102.1000 51.0500
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 11 11.000000 561.5500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 4.000000 204.2000 51.0500
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 1 1.000000 51.0500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.5500 44.5500
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 28.000000 1276.5400 45.5907
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 2 6.000000 315.4200 52.5700
Subtotal (Total Children Is Unduplicated) 4201 13170.75000 879856.1200 66.8038
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 13 30.000000 2111.6600 70.3887
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 132 139.000000 6950.0000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 202 212.750000 10637.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 36 37.750000 943.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 136 143.500000 7162.5000 49.9129
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 455 297.500000 14875.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 8 6.000000 150.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 48 50.750000 2537.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 353 196.250000 9800.0000 49.9363
CONOP-CONOP-CONSULT, OT, PHONE 4 2.500000 62.5000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 70 92.250000 4612.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 373 167.000000 8350.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 145 160.500000 8025.0000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 419 225.250000 11262.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 18 12.750000 318.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1107 2625.750000 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 541 2214.250000 110091.0000 49.7193
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 464 1195.000000 59750.0000 50.0000
INTR-T1013-INTERPRETER 93 265.250000 13262.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 817 3430.000000 34300.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 87 281.250000 20092.5000 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 61 143.750000 10003.4940 69.5895
OCCT-97530TL-OT SESSION BY LICENSED OT 62 201.250000 14377.3000 71.4400
OCCT-97530TLGT-OT SESSION BY LICENSED OT 69 187.750000 13412.8600 71.4400
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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
PHY-97110-PT SESSION BY LICENSED PT 91 331.250000 23664.5000 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 36 73.500000 5250.8400 71.4400
PHY-97110TL-PT SESSION BY LICENSED PT 95 421.250000 30094.1000 71.4400
PHY-97110TLGT-PT SESSION BY LICENSED PT 47 73.000000 5215.1200 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 244 941.500000 66284.8200 70.4034
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 107 257.000000 18111.2000 70.4716
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 127 514.500000 36684.4400 71.3011
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 97 263.250000 18806.5800 71.4400
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 76 81.250000 3006.2500 37.0000
TRAV-TRAVS-Travel by mile 324 21650.00000 9632.9000 0.4449
Subtotal (Total Children Is Unduplicated) 2592 36925.50000 579889.5640 15.7043
-----------------------------------------------------------------------------------------------------------------------
Total 131586.749999 4456334.9240 33.8661
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22773
-----------------------------------------------------------------------------------------------------------------------
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 1 1.000000 50.0000 0.0000
S 1615 1034.500000 45513.7000 0.0000
H 3325 2368.500000 102002.8100 90110.7600
T 1 0.250000 9.2500 0.0000
2523 1604.750000 65645.4300 0.0000
Other 50 26.000000 1380.0000 0.0000
---------------------------------------------------------
Total 7515 5035.000000 214601.1900 90110.7600
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 5037 7170.750000 112108.6700 0.0000
---------------------------------------------------------
Total 5037 7170.750000 112108.6700 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 25.000000 925.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3720 2809.750000 123289.7700 0.0000
P 1 2.000000 150.0000 150.0000
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
5001 3623.250000 154127.2100 0.0000
Other 583 485.000000 20814.9700 0.0000
---------------------------------------------------------
Total 9340 6945.000000 299306.9500 150.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 28 33.750000 1390.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1187 1897.500000 78282.6000 0.0000
P 1910 3248.000000 128132.5000 127758.6800
D 112 183.500000 7568.7500 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
3107 3220.750000 144234.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6344 8583.500000 359608.5500 127758.6800
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.250000 9.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 2419 1577.250000 58358.2500 31101.1400
P 21 442.500000 481.4100 481.4100
D 17 8.250000 305.2500 111.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2549 1362.750000 47443.2500 0.0000
Other 10 4.000000 148.0000 0.0000
---------------------------------------------------------
Total 5017 3395.000000 106745.4100 31693.5500
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
10965 7964.750000 327437.7500 0.0000
Other 196 125.000000 4625.0000 0.0000
---------------------------------------------------------
Total 11161 8089.750000 332062.7500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 1.500000 55.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 501 466.000000 21521.0000 0.0000
P 2691 2299.676400 96526.4800 96415.4400
D 18 29.000000 1757.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 14 28.000000 2100.0000 0.0000
T 0 0.000000 0.0000 0.0000
6662 3554.073600 131033.0200 0.0000
Other 461 223.500000 8349.2500 0.0000
---------------------------------------------------------
Total 10349 6601.750000 261342.2500 96415.4400
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1446 1551.000000 64307.7100 120.2500
P 12950 12491.250000 480450.1840 480497.0400
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 177 285.000000 16166.7500 0.0000
T 1 1.000000 51.0500 63.1400
261 336.500000 17977.2400 0.0000
Other 18 14.000000 649.0000 0.0000
---------------------------------------------------------
Total 14853 14678.750000 579601.9340 480680.4300
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 40 26.750000 989.7500 0.0000
U 0 0.000000 0.0000 0.0000
B 9171 7910.250000 331264.7500 0.0000
P 5 8.000000 524.0000 0.0000
D 55 50.750000 2693.7500 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
6365 5590.750000 244009.0000 0.0000
Other 359 283.500000 11303.5000 0.0000
---------------------------------------------------------
Total 15995 13870.000000 590784.7500 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 4 4.500000 249.7500 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
7 7.500000 465.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11 12.000000 714.7500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 5.500000 203.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 520 557.000000 30973.4800 196.7900
P 1698 1833.500000 83627.6600 82513.5000
D 199 241.250000 12965.1300 260.0000
S 260 238.000000 9588.5000 344.2100
H 145 182.500000 11603.7300 40.0000
T 1469 18392.250000 44230.6500 36935.8900
2088 1307.500000 43125.7300 40.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6388 22757.500000 236318.3800 120330.3900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 13 17.500000 1130.0100 0.0000
P 623 672.500000 36608.3800 36608.3800
D 54 45.500000 2843.5800 0.0000
S 517 275.250000 10306.5000 0.0000
H 52 49.750000 2252.5100 0.0000
T 0 0.000000 0.0000 0.0000
11084 8131.500000 293852.7300 0.0000
Other 77 62.500000 3042.4800 0.0000
---------------------------------------------------------
Total 12420 9254.500000 350036.1900 36608.3800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 53 62.250000 3595.5700 0.0000
P 565 608.250000 33056.2600 33056.3600
D 43 34.250000 1870.2100 0.0000
S 338 298.750000 12005.6000 0.0000
H 5 3.750000 242.0700 0.0000
T 0 0.000000 0.0000 0.0000
13268 10206.750000 376445.3500 0.0000
Other 163 114.750000 5088.2100 196.2500
---------------------------------------------------------
Total 14435 11328.750000 432303.2700 33252.6100
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 2.250000 83.2500 0.0000
U 0 0.000000 0.0000 0.0000
B 1108 1153.000000 55125.4100 0.0000
P 1581 1419.750000 56513.1500 55879.9600
D 0 0.000000 0.0000 0.0000
S 3 3.402799 217.2100 0.0000
H 43 51.000000 3530.0100 0.0000
T 0 0.000000 0.0000 0.0000
4482 2956.097200 119709.8600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7218 5585.499999 235178.8900 55879.9600
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 2.000000 74.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1305 1943.000000 84485.5000 90.0000
P 1768 2529.250000 105657.9900 105551.7500
D 8 15.000000 969.0000 261.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 27 46.000000 1854.0000 1404.2100
3337 3580.250000 146531.0000 0.0000
Other 135 163.500000 6049.5000 0.0000
---------------------------------------------------------
Total 6582 8279.000000 345620.9900 107306.9600