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
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 10461 12755.50000 474165.8000 37.1734
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 510 447.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7604 21425.00000 796387.6500 37.1710
Subtotal (Total Children Is Unduplicated) 14498 34628.25000 1270553.4500 36.6912
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 15 17.000000 824.5000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 42 60.750000 3037.5000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 6 12.000000 600.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 244 343.000000 17150.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 8 16.000000 1200.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 2 4.000000 300.0000 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 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 4 5.000000 365.2500 73.0500
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 4 6.500000 360.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 13 25.000000 1387.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 41 79.060933 5929.5700 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 139 251.500000 18862.5000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 14.000000 1050.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 89 141.500000 10612.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 12 20.000000 1500.0000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 35 64.000000 4762.5000 74.4141
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 135 259.500000 14346.7500 55.2861
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 364 575.000000 31912.5000 55.5000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 68 117.500000 8812.5000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 58 96.000000 7200.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 41 41.000000 3122.1500 76.1500
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 23 23.000000 1150.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 205.6400 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 411.2800 51.4100
Subtotal (Total Children Is Unduplicated) 1000 2206.810933 136750.8700 61.9676
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 19.000000 1367.2400 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 948 2718.000000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 4 10.000000 500.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 62 223.250000 11162.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 29 84.000000 4200.0000 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 21 84.500000 6080.6200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 9 22.000000 1583.1200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 19 83.250000 5990.6700 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 4 6.000000 431.7600 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 41 168.750000 12122.7000 71.8382
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 13 23.250000 1673.0700 71.9600
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) 1916 28888.75000 194171.9800 6.7214
-----------------------------------------------------------------------------------------------------------------------
Total 65723.810933 1601476.3000 24.3668
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 15185
-----------------------------------------------------------------------------------------------------------------------
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 4 1.750000 65.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 2.000000 60.0000 60.0000
1581 962.000000 38514.4300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1587 965.750000 38639.5300 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 2285 5940.750000 43034.6900 0.0000
---------------------------------------------------------
Total 2286 5943.000000 43118.3900 71.9600
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 1 1.000000 0.4400 0.4400
T 0 0.000000 0.0000 0.0000
2589 1624.500000 61952.6000 0.0000
Other 2 2.500000 133.2500 0.0000
---------------------------------------------------------
Total 2592 1628.000000 62086.2900 0.4400
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
2519 2456.500000 101625.8700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2519 2456.500000 101625.8700 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 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
2943 1523.500000 53611.2000 0.0000
Other 5 3.000000 111.6000 0.0000
---------------------------------------------------------
Total 2949 1526.750000 53732.0500 0.0000
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
4880 2948.500000 112327.4300 0.0000
Other 261 183.500000 7000.4300 0.0000
---------------------------------------------------------
Total 5141 3132.000000 119327.8600 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 7 4.250000 158.1000 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
5363 2849.500000 103750.6000 0.0000
Other 1 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 5371 2855.750000 103983.1000 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 6416 6225.250000 241155.2700 241145.9700
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 2863 2797.250000 108684.6800 108684.6800
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9279 9022.500000 349839.9500 349830.6500
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 5 1.750000 65.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4763 3905.750000 155647.2500 0.0000
Other 4 2.750000 102.3000 0.0000
---------------------------------------------------------
Total 4772 3910.250000 155814.6500 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
4 5.000000 326.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4 5.000000 326.2500 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 28 30.250000 1588.3000 0.0000
S 10 3.500000 129.8500 0.0000
H 0 0.000000 0.0000 0.0000
T 1275 15668.250000 22060.3300 21404.3900
2033 1288.250000 37060.7500 30.0000
Other 1 1.000000 37.2000 0.0000
---------------------------------------------------------
Total 3347 16991.250000 60876.4300 21434.3900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 161 92.750000 3414.8000 0.0000
S 97 85.500000 2070.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
7544 5170.750000 127068.8200 0.0000
Other 17 14.000000 520.6000 0.0000
---------------------------------------------------------
Total 7819 5363.000000 133074.2200 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 127 85.000000 3820.2400 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
8501 6021.000000 150769.4500 0.0000
Other 39 28.500000 1134.8000 0.0000
---------------------------------------------------------
Total 8667 6134.500000 155724.4900 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 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
4619 2777.310933 105610.6700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4619 2777.310933 105610.6700 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
3112 3011.750000 117677.9500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3112 3011.750000 117677.9500 0.0000