CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 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 9620 11602.00000 432256.6500 37.2571
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 627 596.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18336 52594.25000 1955807.1500 37.1867
Subtotal (Total Children Is Unduplicated) 19630 64792.25000 2388063.8000 36.8572
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 310.0800 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 11 11.000000 533.5000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 7.000000 350.0000 50.0000
EXIT-EXIT-COS Exit 255 438.000000 21900.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 41 79.000000 5760.2000 72.9139
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 49 89.000000 6675.0000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 14 24.500000 1837.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 19 35.500000 2662.5000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 6 11.500000 862.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 14 26.000000 1950.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 25 39.500000 2962.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 9 18.500000 1387.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 52 97.500000 5411.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 66 122.500000 6798.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 2 4.000000 222.0000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 833 1564.500000 116778.3000 74.6426
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 859 1550.500000 116085.2000 74.8695
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 282 508.500000 38098.5000 74.9233
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 439 771.000000 57825.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 211 386.500000 29070.0000 75.2135
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 165 296.500000 22200.0000 74.8735
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 973 1825.500000 101271.0000 55.4758
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1173 2166.000000 120281.2500 55.5315
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 339 567.000000 42675.0000 75.2646
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 221 397.500000 29812.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 39 39.000000 5931.9000 152.1000
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 1 1.000000 31.4700 31.4700
OCTH-97165-OT EVAL LOW COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97165GT-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 3 3.000000 154.2300 51.4100
PSTH-97162-PT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 16 16.000000 800.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 6 7.000000 359.8700 51.4100
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 9 12.000000 616.9200 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 6.000000 308.4600 51.4100
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 9 22.000000 1164.4600 52.9300
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 16.000000 822.5600 51.4100
Subtotal (Total Children Is Unduplicated) 3588 11178.00000 744732.4600 66.6248
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 8 9.000000 381.6900 42.4100
AACFIT-92609TL-AAC FITTING, ADJUST, TRAINING VISIT 1 3.000000 127.2300 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 14 27.000000 1944.6000 72.0222
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 119 123.250000 6125.0000 49.6957
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 135 149.000000 7450.0000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 27 20.750000 518.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 97 128.250000 6412.5000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 365 220.000000 11000.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 85 99.750000 4939.5000 49.5188
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 362 198.000000 9900.0000 50.0000
CONOP-CONOP-CONSULT, OT, PHONE 5 5.000000 125.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 102 133.500000 6675.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 318 136.750000 6825.0000 49.9086
CONPP-CONPP-CONSULT, PT, PHONE 2 2.000000 50.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 152 165.500000 8275.0000 50.0000
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 292 174.000000 8737.5000 50.2155
CONSP-CONSP-CONSULT, SLP, PHONE 7 5.500000 137.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1102 4196.750000 75.0000 0.0179
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 1.000000 15.0000 15.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.000000 100.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 12 14.500000 725.0000 50.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 657 2637.250000 131752.0000 49.9581
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 274 704.250000 35212.5000 50.0000
EPIC-99601-Early Steps Professional Development Fee 672 2472.000000 37110.0000 15.0121
INTR-T1013-INTERPRETER 80 334.000000 16700.0000 50.0000
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 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
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 420 1569.000000 18828.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 92 310.500000 22343.5800 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 48 92.500000 6744.3400 72.9118
OCCT-97530HM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 107 336.500000 24214.5400 71.9600
OCCT-97530TLGT-OT SESSION BY LICENSED OT 51 109.000000 7843.6400 71.9600
PHY-97110-PT SESSION BY LICENSED PT 112 435.000000 31999.4200 73.5619
PHY-97110GT-PT SESSION BY LICENSED PT 17 19.000000 1367.2400 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 130 625.250000 44992.9900 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 32 42.000000 3022.3200 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 160 574.750000 40990.6900 71.3192
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 50 108.000000 7771.6800 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 108 345.750000 24880.1700 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 48 84.250000 6062.6300 71.9600
TRAV-TRAVS-Travel by mile 331 22445.00000 9985.9000 0.4449
Subtotal (Total Children Is Unduplicated) 2216 39064.50000 552518.5100 14.1438
-----------------------------------------------------------------------------------------------------------------------
Total 115034.750000 3685314.7700 32.0365
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 20335
-----------------------------------------------------------------------------------------------------------------------
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 3 3.000000 171.9600 0.0000
S 21 21.500000 1496.3900 0.0000
H 930 977.500000 60912.6800 39158.7200
T 0 0.000000 0.0000 0.0000
512 491.000000 27060.2800 316.2000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1466 1493.000000 89641.3100 39474.9200
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 1.000000 20.0000 20.0000
0 0.000000 0.0000 0.0000
Other 4261 9545.250000 96816.9200 0.0000
---------------------------------------------------------
Total 4262 9546.250000 96836.9200 20.0000
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 1 1.000000 98.7800 98.7800
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
2736 1847.000000 71328.8300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2737 1848.000000 71427.6100 98.7800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 2 4.000000 148.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 1881 3157.500000 126077.2000 0.0000
P 273 465.500000 18130.6500 17974.0500
D 108 157.250000 5877.1500 0.0000
S 2 3.750000 139.5000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2892 3507.500000 159720.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 5158 7295.500000 310093.4200 17974.0500
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 74 55.750000 2073.9000 0.0000
U 0 0.000000 0.0000 0.0000
B 2443 1473.250000 54804.9000 39813.3000
P 0 0.000000 0.0000 0.0000
D 40 21.500000 799.8000 55.8000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
2667 1367.500000 46686.0000 0.0000
Other 54 35.250000 1311.3000 0.0000
---------------------------------------------------------
Total 5278 2953.250000 105675.9000 39869.1000
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 3 3.750000 139.5000 0.0000
9693 6916.500000 289053.1100 0.0000
Other 360 221.000000 8221.2000 0.0000
---------------------------------------------------------
Total 10057 7141.750000 297432.4100 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 19.500000 725.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 818 730.250000 35573.5000 0.0000
P 1641 1312.673300 56204.8975 56204.8900
D 10 3.250000 120.9000 0.0000
S 1 0.250000 9.3000 0.0000
H 3 6.000000 450.0000 0.0000
T 0 0.000000 0.0000 0.0000
5920 3145.576700 118343.2525 0.0000
Other 268 154.500000 6501.0000 0.0000
---------------------------------------------------------
Total 8692 5372.000000 217928.2500 56204.8900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 95 88.500000 3447.6800 0.0000
U 0 0.000000 0.0000 0.0000
B 3004 3165.750000 129606.6800 0.0000
P 6600 6389.000000 245634.7400 245634.7400
D 1 2.000000 74.4000 0.0000
S 0 0.000000 0.0000 0.0000
H 192 281.000000 15691.2000 0.0000
T 114 82.500000 3248.2000 3248.2000
1294 1460.000000 63990.5900 0.0000
Other 16 21.000000 856.8000 0.0000
---------------------------------------------------------
Total 11316 11489.750000 462550.2900 248882.9400
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 313 262.000000 9858.6000 0.0000
U 0 0.000000 0.0000 0.0000
B 7504 6637.000000 288286.8000 0.0000
P 11 18.250000 1098.7500 0.0000
D 87 70.000000 2893.6500 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
5727 5128.000000 230298.8000 0.0000
Other 458 353.750000 13430.4000 0.0000
---------------------------------------------------------
Total 14100 12469.000000 545867.0000 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 25 25.500000 1415.2500 0.0000
P 1 1.000000 71.9600 71.9600
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
10 10.000000 544.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 36 36.500000 2031.2100 71.9600
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 31 30.250000 1808.8200 0.0000
U 0 0.000000 0.0000 0.0000
B 807 767.250000 36200.8600 50.0000
P 1336 1297.500000 63982.8800 62897.1100
D 76 75.500000 5371.8700 0.0000
S 185 151.750000 6040.6000 177.2000
H 80 103.250000 7543.8100 48.0000
T 2581 16945.750000 49223.6100 42579.8400
2638 3168.250000 62982.9200 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 7735 22539.750000 233164.6700 105761.4500
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 67 51.000000 3019.6500 0.0000
U 0 0.000000 0.0000 0.0000
B 676 604.000000 31641.9800 0.0000
P 1934 1742.750000 86358.9000 86343.3400
D 254 227.750000 11580.8000 0.0000
S 35 38.500000 2574.9700 0.0000
H 138 141.000000 10140.4400 0.0000
T 1 2.000000 111.0000 0.0000
8094 5471.000000 150155.8000 0.0000
Other 229 192.000000 10126.3400 0.0000
---------------------------------------------------------
Total 11428 8470.000000 305709.8800 86343.3400
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 68 70.250000 4237.4400 0.0000
U 0 0.000000 0.0000 0.0000
B 878 845.750000 39518.5000 109.1600
P 3008 2709.250000 127054.5900 126224.2400
D 273 234.000000 12603.4000 0.0000
S 12 11.000000 599.4400 0.0000
H 130 131.500000 8918.9600 0.0000
T 1 0.250000 9.3000 0.0000
8319 6454.750000 179311.9100 0.0000
Other 261 213.000000 9895.4900 37.5000
---------------------------------------------------------
Total 12950 10669.750000 382149.0300 126370.9000
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1757 1685.250000 71508.6500 0.0000
P 1114 1049.500000 41026.6000 40913.8000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 42 81.000000 6065.8800 0.0000
T 0 0.000000 0.0000 0.0000
5045 3815.250000 150016.1200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7958 6631.000000 268617.2500 40913.8000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 177 246.000000 9151.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2621 3594.000000 152494.8000 0.0000
P 1 2.000000 111.0000 111.0000
D 4 8.000000 522.0000 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
3017 3039.250000 126842.6200 0.0000
Other 182 190.000000 7068.0000 0.0000
---------------------------------------------------------
Total 6002 7079.250000 296189.6200 111.0000