CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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 10818 14549.50000 540731.0000 37.1649
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 649 622.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 19714 60985.83410 2267742.7285 37.1847
Subtotal (Total Children Is Unduplicated) 21033 76157.83410 2808473.7285 36.8770
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 27 29.000000 1406.5000 48.5000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 2.000000 250.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 16 26.000000 1300.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 11 22.000000 1100.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 253 444.750000 22237.5000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 39 65.500000 4912.5000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 49 87.500000 6495.7500 74.2371
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 12 22.000000 1650.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 25 43.500000 3262.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 8 15.000000 1125.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 17 32.500000 2437.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 32.000000 2400.0000 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 46 82.500000 4578.7500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 76 139.000000 7714.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 887 1618.665899 119249.0925 73.6712
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 835 1546.000000 115723.5000 74.8535
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 191 345.999999 25912.5000 74.8916
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 496 907.500000 68062.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 228 444.000300 33300.0225 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 284 510.500000 38287.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1060 2016.500000 111888.0000 55.4862
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1289 2405.000000 133426.8000 55.4789
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 412 720.500000 53962.5000 74.8959
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 119 227.000000 17025.0000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 81 81.000000 10497.3000 129.5963
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
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 34 34.000000 1700.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92521TL-EVAL OF SPEECH FLUENCY 1 2.000000 102.8200 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 17 19.000000 865.1600 45.5347
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 10 11.000000 565.5100 51.4100
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 4 4.000000 205.6400 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 11 38.000000 1884.8200 49.6005
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 7 26.000000 1371.6200 52.7546
Subtotal (Total Children Is Unduplicated) 3796 12013.91620 795742.1250 66.2350
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 17 34.000000 2518.6000 74.0765
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 95 90.250000 4512.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 162 170.500000 8525.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 37 36.250000 906.2500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 125 145.500000 7275.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 407 260.500000 13025.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 4 2.250000 56.2500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 52 60.750000 3037.5000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 420 247.250000 12287.5000 49.6967
CONOP-CONOP-CONSULT, OT, PHONE 2 1.000000 25.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 84 96.500000 4825.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 379 183.000000 9112.5000 49.7951
CONPP-CONPP-CONSULT, PT, PHONE 3 1.250000 31.2500 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 170 198.500000 9925.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 346 194.500000 9712.5000 49.9357
CONSP-CONSP-CONSULT, SLP, PHONE 9 4.250000 106.2500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1133 3135.499700 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 15 63.500000 3137.5000 49.4094
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 625 3030.000000 148780.3000 49.1024
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 261 741.500000 37043.5000 49.9575
INTR-T1013-INTERPRETER 126 515.750000 25787.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 1066 5114.000000 51140.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 66 250.000000 17990.0000 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 38 113.250000 8413.5900 74.2922
OCCT-97530HM-OT SESSION BY OT ASST 2 10.000000 526.9200 52.6920
OCCT-97530TL-OT SESSION BY LICENSED OT 76 342.000000 24448.4100 71.4866
OCCT-97530TLGT-OT SESSION BY LICENSED OT 38 108.500000 7807.6600 71.9600
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 79 368.250000 26499.2700 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 13 20.000000 1439.2000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 117 529.500000 38066.8400 71.8920
PHY-97110TLGT-PT SESSION BY LICENSED PT 26 38.000000 2734.4800 71.9600
CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2023 ending 06/30/2023 Date of Report:07/25/2023 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-92507-SPL THERAPY SESSION BY LICENSED SLP 153 714.000000 49348.7800 69.1159
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 50 126.500000 9083.9100 71.8096
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 125 551.750000 39626.3300 71.8194
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 42 103.500000 7447.8600 71.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 50 73.000000 2701.0000 37.0000
TRAV-TRAVS-Travel by mile 397 28684.00000 12762.5900 0.4449
Subtotal (Total Children Is Unduplicated) 2232 46359.74970 600724.3400 12.9579
-----------------------------------------------------------------------------------------------------------------------
Total 134531.499998 4204940.1935 31.2562
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 21327
-----------------------------------------------------------------------------------------------------------------------
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 255 63.750000 2371.5000 2371.5000
T 1 1.000000 10.0000 10.0000
117 30.000000 1128.8000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 374 95.000000 3519.6000 2381.5000
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 0.500000 18.6000 0.0000
0 0.000000 0.0000 0.0000
Other 4083 9792.000000 92933.8400 0.0000
---------------------------------------------------------
Total 4084 9792.500000 92952.4400 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 4 3.000000 111.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 210 122.250000 4692.8000 0.0000
P 144 111.000000 4618.2500 4619.0900
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
3898 2821.000000 108391.8500 0.0000
Other 39 39.500000 1570.0500 0.0000
---------------------------------------------------------
Total 4295 3096.750000 119384.5500 4619.0900
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 174 297.250000 11590.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 1849 3046.250000 118327.8000 0.0000
P 679 1156.500000 45718.8000 45696.5000
D 200 320.500000 12100.6500 0.0000
S 3 4.250000 158.1000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
3272 3796.750000 173788.4200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6177 8621.500000 361683.8200 45696.5000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 13.750000 511.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2774 1695.000000 63054.0000 31210.7000
P 0 0.000000 0.0000 0.0000
D 16 12.250000 455.7000 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
2848 1486.250000 50647.8000 0.0000
Other 37 27.000000 1004.4000 0.0000
---------------------------------------------------------
Total 5706 3234.250000 115673.4000 31210.7000
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 2 4.000000 261.0000 0.0000
9043 6606.000000 280709.6200 0.0000
Other 319 188.250000 7115.1000 0.0000
---------------------------------------------------------
Total 9364 6798.250000 288085.7200 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 60 48.500000 2255.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 1140 918.000000 41998.2000 0.0000
P 1822 1475.082800 62614.9100 62549.8000
D 7 7.500000 430.2000 0.0000
S 1 0.250000 9.3000 0.0000
H 37 74.000000 5550.0000 0.0000
T 0 0.000000 0.0000 0.0000
6693 3529.417200 131924.3835 0.0000
Other 354 188.000000 7596.0000 0.0000
---------------------------------------------------------
Total 10114 6240.750000 252378.3935 62549.8000
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 186 182.500000 7056.0400 0.0000
U 0 0.000000 0.0000 0.0000
B 4120 4312.750000 174961.7800 0.0000
P 7481 7178.250000 277304.0700 277304.0700
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 258 340.500000 19102.2000 0.0000
T 3068 3114.000000 120157.0300 120157.0300
256 360.000000 18607.9300 0.0000
Other 10 16.500000 790.6000 0.0000
---------------------------------------------------------
Total 15379 15504.500000 617979.6500 397461.1000
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 75 65.500000 2436.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 9098 7978.250000 334180.9500 0.0000
P 3 3.000000 196.8000 37.5000
D 122 176.000000 11740.5000 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
6098 5587.750000 247302.0000 0.0000
Other 429 302.750000 11262.3000 0.0000
---------------------------------------------------------
Total 15825 14113.250000 607119.1500 37.5000
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 1.000000 55.5000 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
8 12.000000 666.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 13.000000 721.5000 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 939 969.000000 51434.5700 0.0000
P 1343 1407.250000 64995.9600 63486.9100
D 196 217.750000 11672.7600 172.8000
S 144 142.000000 6122.1000 571.2000
H 257 318.750000 20885.8100 0.0000
T 2305 23472.750000 62174.1900 52661.5900
2416 1488.500000 51513.1800 115.2000
Other 2 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 7613 28026.750000 269324.8900 117007.7000
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 114 113.000000 7775.9100 0.0000
U 0 0.000000 0.0000 0.0000
B 1174 1043.500000 51417.9900 0.0000
P 2055 1854.000000 92204.5200 91937.0600
D 334 243.750000 10983.1600 0.0000
S 111 106.750000 5014.0000 0.0000
H 43 43.500000 3136.3400 0.0000
T 0 0.000000 0.0000 0.0000
10061 6881.750000 190016.0800 0.0000
Other 191 155.000000 7625.9400 59.2500
---------------------------------------------------------
Total 14083 10441.250000 368173.9400 91996.3100
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 9 8.750000 325.5000 0.0000
U 0 0.000000 0.0000 0.0000
B 2212 2035.500000 96245.0900 0.0000
P 2900 2523.310000 116637.7400 116548.4400
D 323 263.750000 12986.1000 0.0000
S 16 14.000000 752.2400 0.0000
H 85 85.750000 6142.7800 0.0000
T 0 0.000000 0.0000 0.0000
9831 7459.000000 204855.4900 0.0000
Other 212 156.440000 6934.3400 504.7400
---------------------------------------------------------
Total 15588 12546.500000 444879.2800 117053.1800
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2465 2384.500000 102376.2900 0.0000
P 1308 1218.500000 50120.0000 49389.6500
D 1 0.250000 9.3000 0.0000
S 0 0.000000 0.0000 0.0000
H 56 97.000000 7147.2000 0.0000
T 0 0.000000 0.0000 0.0000
4992 3691.249998 141795.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 8822 7391.499998 301447.9100 49389.6500
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 15 24.750000 920.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 2472 3481.500000 145339.2000 139.5000
P 985 1409.000000 62558.8500 63766.0300
D 16 26.750000 1640.2500 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 7 12.500000 820.5000 340.2000
3410 3510.500000 144728.5500 89.7000
Other 135 150.750000 5607.9000 0.0000
---------------------------------------------------------
Total 7040 8615.750000 361615.9500 64335.4300