CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 10461 12757.00000 474221.6000 37.1734
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 510 447.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19707 57429.00000 2134800.2500 37.1729
Subtotal (Total Children Is Unduplicated) 21189 70633.75000 2609021.8500 36.9373
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 44 64.750000 3237.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 248 350.000000 17500.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 25 48.000000 3600.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 38 70.500000 5287.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 3 6.000000 450.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 32 57.000000 4275.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 17.000000 1275.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 12 23.500000 1762.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 14 27.500000 2062.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 12 19.000000 1395.7500 73.4605
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 49.000000 2719.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 71 128.500000 7082.6100 55.1176
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 479 921.500000 68395.0000 74.2214
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 898 1599.000000 119845.7500 74.9504
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 161 298.000000 22275.0000 74.7483
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 568 953.500000 71378.5000 74.8595
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 169 323.500000 24092.5000 74.4745
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 291 543.500000 40725.0000 74.9310
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 592 1132.500000 62798.2500 55.4510
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1542 2819.000000 156403.2500 55.4818
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 344 634.000000 47550.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 298 512.500000 38437.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 67 67.000000 7836.2500 116.9590
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 3 3.000000 417.4700 139.1567
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 53 54.000000 2654.0000 49.1481
SPCH-92521-EVAL OF SPEECH FLUENCY 5 6.000000 307.7400 51.2900
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 14 14.000000 719.7400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 9.000000 462.6900 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 308.4600 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 5 16.000000 781.0200 48.8138
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 14.000000 741.0200 52.9300
Subtotal (Total Children Is Unduplicated) 3586 10821.75000 718503.4100 66.3944
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 14 36.000000 2590.5600 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 110 114.250000 5712.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 185 215.750000 10787.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 29.500000 737.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 91 84.250000 4200.0000 49.8516
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 358 219.500000 10962.5000 49.9431
CONIP-CONIP-CONSULT, ITDS PHONE 4 3.750000 93.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 49 49.250000 2462.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 367 197.000000 9837.5000 49.9365
CONOP-CONOP-CONSULT, OT, PHONE 4 3.000000 75.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 76 86.250000 4312.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 368 169.250000 8462.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 4 3.250000 81.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 142 161.250000 8062.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 346 184.500000 9225.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 10 7.500000 187.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 949 2723.500000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 7 12.500000 625.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 571 2241.000000 112050.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 253 666.750000 33337.5000 50.0000
INTR-T1013-INTERPRETER 116 458.750000 22937.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 941 3974.000000 39740.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 94 298.750000 21498.0500 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 38 62.000000 4461.5200 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 77 303.000000 21803.8800 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 38 81.000000 5828.7600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 89 362.250000 26067.5100 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 21 31.750000 2284.7300 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 104 415.500000 29899.3800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 20 25.750000 1852.9700 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 182 752.500000 54129.3500 71.9327
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 54 95.500000 6872.1800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 104 451.500000 32427.4600 71.8216
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2022 ending 12/31/2022 Date of Report:01/23/2023 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 46 110.750000 7969.5700 71.9600
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.9200 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 65 68.750000 2543.7500 37.0000
TRAV-TRAVS-Travel by mile 323 19417.00000 8639.0500 0.4449
Subtotal (Total Children Is Unduplicated) 2133 34118.75000 512786.6400 15.0295
-----------------------------------------------------------------------------------------------------------------------
Total 115574.250000 3840311.9000 33.2281
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21592
-----------------------------------------------------------------------------------------------------------------------
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 3402 2264.500000 96996.8200 0.0000
H 150 180.000000 12223.5200 0.0000
T 2 2.000000 60.0000 60.0000
1655 1049.750000 44431.3100 0.0000
Other 25 11.000000 560.4000 0.0000
---------------------------------------------------------
Total 5234 3507.250000 154272.0500 60.0000
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 1 2.250000 83.7000 71.9600
0 0.000000 0.0000 0.0000
Other 3341 6765.250000 79467.3900 0.0000
---------------------------------------------------------
Total 3342 6767.500000 79551.0900 71.9600
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 46 27.500000 1023.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2064 1444.250000 55638.8500 0.0000
P 39 45.750000 2056.7500 2056.7500
D 3 4.250000 214.8000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 3.000000 150.4400 150.4400
T 0 0.000000 0.0000 0.0000
2596 1632.500000 62338.6000 0.0000
Other 134 140.250000 5495.9500 0.0000
---------------------------------------------------------
Total 4884 3297.500000 126918.3900 2207.1900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 81 111.750000 4363.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1642 2438.250000 97706.4000 0.0000
P 837 1356.250000 54258.5000 51520.8200
D 54 69.500000 2805.0000 0.0000
S 1 0.750000 27.9000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2939 3014.500000 134031.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5554 6991.000000 293193.0200 51520.8200
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 2733 1628.750000 60549.6000 28183.9800
P 0 0.000000 0.0000 0.0000
D 1 0.250000 9.2500 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
2945 1524.250000 53639.1000 0.0000
Other 40 27.250000 1012.6000 0.0000
---------------------------------------------------------
Total 5725 3183.500000 115322.1500 28183.9800
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
10133 7259.750000 300952.8800 0.0000
Other 261 183.500000 7000.4300 0.0000
---------------------------------------------------------
Total 10394 7443.250000 307953.3100 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 12.250000 455.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 980 769.250000 33310.3000 0.0000
P 1516 1308.750000 58666.9500 65920.2500
D 10 10.250000 608.1000 0.0000
S 13 13.250000 492.9000 0.0000
H 8 16.000000 1200.0000 0.0000
T 0 0.000000 0.0000 0.0000
5424 2940.250000 110074.9000 0.0000
Other 353 173.250000 6440.9000 0.0000
---------------------------------------------------------
Total 8319 5243.250000 211249.7500 65920.2500
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1726 1924.750000 77599.4700 5074.7600
P 8469 8445.750000 330736.0800 330968.4300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 215 321.500000 17996.6000 0.0000
T 2875 2814.000000 109321.8300 109321.2300
161 234.250000 12881.1200 0.0000
Other 5 5.500000 241.2000 0.0000
---------------------------------------------------------
Total 13458 13749.750000 548925.1000 445364.4200
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 42.250000 1796.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 8174 7033.750000 297691.8000 0.0000
P 0 0.000000 0.0000 0.0000
D 105 132.000000 7839.9000 0.0000
S 380 220.750000 8324.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5426 4764.500000 209350.5000 0.0000
Other 635 600.000000 25561.3500 0.0000
---------------------------------------------------------
Total 14769 12793.250000 550563.7500 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 9 13.000000 887.2500 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
4 5.000000 326.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13 18.000000 1213.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 35 36.750000 2493.7200 0.0000
U 0 0.000000 0.0000 0.0000
B 1028 1012.250000 48531.2900 27.9000
P 840 881.000000 42699.8900 162013.2700
D 229 241.250000 12709.7600 0.0000
S 106 77.000000 2901.4500 0.0000
H 129 164.750000 10719.2800 0.0000
T 1508 15921.750000 37127.7700 31515.5700
2277 1570.500000 52906.6200 30.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 6153 19906.250000 210126.9800 193586.7400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 42 41.000000 2608.1800 0.0000
U 0 0.000000 0.0000 0.0000
B 772 724.750000 38428.6200 18.6000
P 1732 1571.250000 78346.1500 78318.0800
D 260 178.500000 7556.5600 0.0000
S 132 124.000000 4424.1400 0.0000
H 10 10.000000 675.6800 0.0000
T 0 0.000000 0.0000 0.0000
8136 5770.750000 164775.3800 0.0000
Other 138 108.000000 4319.5400 0.0000
---------------------------------------------------------
Total 11222 8528.250000 301134.2500 78336.6800
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 32 34.000000 2210.2200 0.0000
U 0 0.000000 0.0000 0.0000
B 1054 963.250000 45400.8100 9.3000
P 3723 3188.750000 147542.3100 147333.4000
D 251 211.750000 10787.8900 0.0000
S 0 0.000000 0.0000 0.0000
H 23 22.500000 1619.1000 0.0000
T 0 0.000000 0.0000 0.0000
9077 6635.250000 190314.1500 0.0000
Other 151 114.250000 4950.5600 1147.2000
---------------------------------------------------------
Total 14311 11169.750000 402825.0400 148489.9000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1904 1560.750000 66717.5100 0.0000
P 835 755.250000 30443.9500 30443.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 38 52.500000 3676.5900 0.0000
T 0 0.000000 0.0000 0.0000
4793 2940.750000 114361.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7570 5309.250000 215199.7700 30443.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 134 177.000000 6584.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1781 2491.750000 105369.9500 0.0000
P 816 1233.250000 54598.4500 54784.7060
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 81 121.250000 4510.5000 4486.3000
3296 3357.750000 140180.5000 0.0000
Other 259 285.000000 10601.3500 0.0000
---------------------------------------------------------
Total 6367 7666.000000 321845.1500 59271.0060