CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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 11048 14102.75000 524419.6000 37.1856
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 665 678.750000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 20879 64220.00000 2388378.3000 37.1906
Subtotal (Total Children Is Unduplicated) 22192 79001.50000 2912797.9000 36.8702
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 16 18.000000 873.0000 48.5000
EVAL-96111-DEVELOPMENTAL EVALUATION 41 60.000000 3000.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 5 9.000000 450.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 236 342.250000 17112.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 46 84.500000 6337.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 56 97.000000 7275.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 11 18.500000 1387.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 37 67.000000 5025.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 10 20.000000 1500.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 16 29.500000 2212.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 20 33.500000 2512.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 15 25.000000 1875.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 41 73.500000 4079.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 93 164.000000 9102.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 707 1296.499997 96633.0000 74.5337
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 916 1624.999999 121544.1900 74.7964
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 218 367.000000 27525.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 543 968.000000 72555.1500 74.9537
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 193 353.500000 26512.5000 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 282 511.000000 38325.0000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 985 1818.500000 100871.2500 55.4695
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1502 2726.500000 151170.7500 55.4450
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 489 854.000000 64012.5000 74.9561
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 258 486.500000 36424.9950 74.8715
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 77 77.000000 11331.9500 147.1682
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
SCREEN-T1023-SCREENING 39 39.000000 1950.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 4 4.000000 205.6400 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 2 2.000000 102.8200 51.4100
SPCH-92521TLGT-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 9.000000 462.6900 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 7 7.000000 359.8700 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 6 8.000000 344.3400 43.0425
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 9 31.000000 1640.8300 52.9300
Subtotal (Total Children Is Unduplicated) 4097 12238.25000 815362.6150 66.6241
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 18 38.000000 2734.4800 71.9600
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 118 120.750000 6037.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT,PROF,FACE TO FACE 179 197.250000 9862.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 52 46.750000 1168.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 119 139.500000 6975.0000 50.0000
CONIF-CONIFGT-CONSULT,ITDS,FACE TO FACE 450 290.000000 14487.5000 49.9569
CONIP-CONIP-CONSULT, ITDS PHONE 9 7.500000 187.5000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 95 106.250000 5312.5000 50.0000
CONOF-CONOFGT-CONSULT,OT,FACE TO FACE 382 203.750000 10175.0000 49.9387
CONOP-CONOP-CONSULT, OT, PHONE 5 2.750000 68.7500 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 90 111.250000 5562.5000 50.0000
CONPF-CONPFGT-CONSULT,PT,FACE TO FACE 376 169.750000 8487.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 2 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 168 185.750000 9287.5000 50.0000
CONSF-CONSFGT-CONSULT,SLP,FACE TO FACE 382 229.500000 11475.0000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 16 13.750000 343.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1114 3129.250000 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 5 16.000000 800.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 642 2882.000000 144010.0000 49.9688
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 284 763.750000 38187.5000 50.0000
INTR-T1013-INTERPRETER 105 433.500000 21675.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1045 4622.000000 46210.0000 9.9978
OCCT-97530-OT SESSION BY LICENSED OT 103 371.500000 26733.1400 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 41 95.250000 6854.1900 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 2 10.000000 576.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 102 373.250000 26859.0700 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 52 128.500000 9246.8600 71.9600
PHY-97110-PT SESSION BY LICENSED PT 92 381.250000 27434.7500 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 17 27.500000 1978.9000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 112 501.250000 36069.9500 71.9600
CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2023 ending 03/31/2023 Date of Report:04/20/2023 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
PHY-97110TLGT-PT SESSION BY LICENSED PT 27 36.250000 2608.5500 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 174 770.750000 54324.0800 70.4821
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 62 124.500000 8959.0200 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 110 415.250000 29791.3900 71.7433
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 50 131.500000 9462.7400 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 42 55.000000 2035.0000 37.0000
TRAV-TRAVS-Travel by mile 367 26461.00000 11770.2500 0.4448
Subtotal (Total Children Is Unduplicated) 2299 43593.00000 597783.3700 13.7128
-----------------------------------------------------------------------------------------------------------------------
Total 134832.749996 4325943.8850 32.0838
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 22537
-----------------------------------------------------------------------------------------------------------------------
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 3714 2658.000000 120285.0700 0.0000
H 239 280.250000 18982.4700 0.0000
T 0 0.000000 0.0000 0.0000
1940 1340.500000 59835.9200 0.0000
Other 49 22.000000 875.1000 0.0000
---------------------------------------------------------
Total 5942 4300.750000 199978.5600 0.0000
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 4607 12243.250000 106604.6700 0.0000
---------------------------------------------------------
Total 4607 12243.250000 106604.6700 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 49 63.500000 2362.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 1884 1218.750000 46382.6000 0.0000
P 167 95.250000 3810.3500 3739.6500
D 18 13.500000 710.1000 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
2620 1678.500000 64667.3000 0.0000
Other 171 147.750000 5668.7000 0.0000
---------------------------------------------------------
Total 4909 3217.250000 123601.2500 3739.6500
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2139 3196.500000 124888.6500 0.0000
P 535 882.250000 35895.3000 35697.0500
D 110 126.500000 4872.3000 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
3752 4332.250000 194273.0200 0.0000
Other 1 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 6537 8539.000000 359985.0700 35697.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3136 1854.250000 68978.1000 13640.7000
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
3101 1631.250000 55939.5000 0.0000
Other 95 67.000000 2492.4000 0.0000
---------------------------------------------------------
Total 6332 3552.500000 127410.0000 13640.7000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 1 0.500000 18.6000 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
10502 7698.500000 323973.7300 0.0000
Other 262 169.000000 7178.0200 0.0000
---------------------------------------------------------
Total 10765 7868.000000 331170.3500 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 6.000000 223.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 845 722.250000 32492.1000 0.0000
P 1692 1415.549400 61173.7000 61052.8000
D 2 1.500000 55.8000 0.0000
S 1 0.500000 18.6000 0.0000
H 4 8.000000 600.0000 0.0000
T 0 0.000000 0.0000 0.0000
6040 3140.950600 117042.2950 0.0000
Other 315 174.750000 7115.9000 0.0000
---------------------------------------------------------
Total 8906 5469.500000 218721.5950 61052.8000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3374 3601.000000 141764.6000 211.0000
P 7511 7325.000000 285279.5900 285200.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 246 342.000000 19117.8000 0.0000
T 32 34.750000 1395.1000 1395.1000
4132 4155.500000 165073.3700 0.0000
Other 1 1.250000 46.5000 0.0000
---------------------------------------------------------
Total 15296 15459.500000 612676.9600 286806.9000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 7 5.000000 186.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 9658 8202.250000 340864.0500 0.0000
P 0 0.000000 0.0000 0.0000
D 163 186.500000 10905.6000 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
5965 5101.500000 222196.1500 0.0000
Other 397 297.500000 11067.0000 0.0000
---------------------------------------------------------
Total 16190 13792.750000 585218.8000 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 7 13.000000 750.7500 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
6 12.000000 695.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 13 25.000000 1446.0000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 17 19.000000 845.8400 0.0000
U 0 0.000000 0.0000 0.0000
B 826 835.000000 42160.2400 0.0000
P 1534 1585.250000 73642.8000 72478.1500
D 266 281.000000 15052.0000 515.0000
S 139 118.750000 5646.9200 700.1000
H 222 264.000000 15552.5500 0.0000
T 1898 18706.000000 52184.2200 43714.9000
2309 1429.000000 46891.4800 195.3400
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7211 23238.000000 251976.0500 117603.4900
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 6 5.250000 246.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 519 488.000000 25917.9300 0.0000
P 2286 2137.750000 107974.1300 107923.1900
D 265 193.750000 9640.9300 0.0000
S 209 159.250000 6072.6000 0.0000
H 42 42.000000 2821.6300 0.0000
T 0 0.000000 0.0000 0.0000
8999 6402.500000 175643.5800 0.0000
Other 215 176.250000 7532.6400 0.0000
---------------------------------------------------------
Total 12541 9604.750000 335849.9400 107923.1900
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 17.750000 805.4200 0.0000
U 0 0.000000 0.0000 0.0000
B 986 913.250000 45206.5200 109.1600
P 4330 3916.500000 180403.4300 180221.3200
D 234 196.500000 10635.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 82 85.000000 5705.6900 0.0000
T 0 0.000000 0.0000 0.0000
9460 6871.250000 186881.0000 0.0000
Other 149 113.000000 4927.4000 329.9200
---------------------------------------------------------
Total 15256 12113.250000 434564.8600 180660.4000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2488 2371.250000 102124.4500 0.0000
P 952 887.000000 36310.8000 36310.8000
D 0 0.000000 0.0000 0.0000
S 2 3.273600 245.5200 0.0000
H 70 111.000000 8161.0700 0.0000
T 0 0.000000 0.0000 0.0000
5584 3705.226396 141056.3500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9096 7077.749996 287898.1900 36310.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2288 3279.250000 137300.4000 251.1000
P 1047 1531.500000 67767.4500 67580.9400
D 2 4.000000 261.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 13.500000 944.2500 488.8500
3198 3282.750000 134365.8900 150.0000
Other 193 220.500000 8202.6000 0.0000
---------------------------------------------------------
Total 6735 8331.500000 348841.5900 68470.8900