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
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 9620 11601.25000 432228.7500 37.2571
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 627 596.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7499 20634.50000 767217.8000 37.1813
Subtotal (Total Children Is Unduplicated) 13626 32831.75000 1199446.5500 36.5331
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Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 11 11.000000 533.5000 48.5000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 3 6.000000 300.0000 50.0000
EXIT-EXIT-COS Exit 254 437.500000 21875.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 10 18.500000 1387.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 3.500000 262.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 7 13.500000 1012.5000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 3 5.500000 412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 5 10.000000 750.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 3.500000 262.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 8 15.000000 832.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 12 21.500000 1193.2500 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 133 227.333334 17050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 103 189.000000 14175.0000 75.0000
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 36 50.590400 3794.2800 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 53 95.500000 7162.5000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 21 33.033300 2477.4975 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 16 29.500000 2212.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 238 467.500000 25918.5000 55.4406
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 181 338.500000 18816.0000 55.5864
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 59 94.000000 7050.0000 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 40 69.953000 5246.4750 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 1 1.000000 50.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.8200 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 5.000000 257.0500 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 5.000000 264.6500 52.9300
Subtotal (Total Children Is Unduplicated) 872 2167.410034 134276.6625 61.9526
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 2 2.000000 84.8200 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 10 20.000000 1492.8400 74.6420
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 151 164.500000 8225.0000 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 1099 4182.750000 75.0000 0.0179
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 1.000000 15.0000 15.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 2.000000 100.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 90 351.750000 17587.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 39 122.000000 6100.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 672 2471.000000 37095.0000 15.0121
INTR-T1013-INTERPRETER 80 334.000000 16700.0000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 420 1569.000000 18828.0000 12.0000
OCCT-97530-OT SESSION BY LICENSED OT 28 77.000000 5540.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 8 9.250000 665.6300 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 3 3.000000 215.8800 71.9600
PHY-97110-PT SESSION BY LICENSED PT 16 57.000000 4101.7200 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 2 3.000000 215.8800 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 1 0.500000 35.9800 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 105.250000 7573.7900 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 14 41.000000 2950.3600 71.9600
TRAV-TRAVS-Travel by mile 331 22445.00000 9985.9000 0.4449
Subtotal (Total Children Is Unduplicated) 2003 33358.75000 206534.9700 6.1913
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Total 68357.910034 1540258.1825 22.5323
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Number of Children (Unduplicated) With at Least One Service 14375
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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 1 1.000000 50.0000 0.0000
S 1 1.000000 37.2000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
351 326.000000 16742.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 353 328.000000 16829.6800 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 2803 8570.750000 55689.1000 0.0000
---------------------------------------------------------
Total 2803 8570.750000 55689.1000 0.0000
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
965 631.000000 23846.9300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 966 632.000000 23945.7100 98.7800
Center 04
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 37.2000 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
2176 2555.500000 103603.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2177 2556.500000 103641.1000 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 25 13.000000 483.6000 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
2664 1366.500000 46648.8000 0.0000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 2690 1380.250000 47160.3000 55.8000
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 3 3.750000 139.5000 0.0000
4450 2608.000000 98467.8600 0.0000
Other 360 221.000000 8221.2000 0.0000
---------------------------------------------------------
Total 4813 2832.750000 106828.5600 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 10 3.250000 120.9000 0.0000
S 1 0.250000 9.3000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5848 3012.326700 108717.7525 0.0000
Other 5 2.750000 102.3000 0.0000
---------------------------------------------------------
Total 5864 3018.576700 108950.2525 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 6508 6292.000000 241391.7200 241391.7200
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 114 82.500000 3248.2000 3248.2000
1171 1260.000000 50974.3300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7793 7634.500000 295614.2500 244639.9200
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 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4946 4026.750000 160422.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4946 4026.750000 160422.1500 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 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
8 6.500000 360.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 7.500000 432.7100 71.9600
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 1 0.250000 9.3000 9.3000
D 9 8.000000 581.7600 0.0000
S 37 15.000000 558.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2207 16551.500000 28308.8400 26855.1400
2346 2849.750000 45157.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4600 19424.500000 74615.1500 26864.4400
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 168 123.000000 5243.4600 0.0000
S 4 5.500000 232.0500 0.0000
H 1 1.000000 71.9600 0.0000
T 0 0.000000 0.0000 0.0000
7836 5213.000000 133739.7400 0.0000
Other 18 10.750000 399.9000 0.0000
---------------------------------------------------------
Total 8027 5353.250000 139687.1100 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 184 145.000000 6792.1600 0.0000
S 1 2.000000 74.4000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.3000 0.0000
7989 6086.500000 155302.1400 0.0000
Other 108 86.250000 3359.7000 0.0000
---------------------------------------------------------
Total 8283 6320.000000 165537.7000 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 1 2.000000 150.0000 0.0000
T 0 0.000000 0.0000 0.0000
4836 3562.583334 135551.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4837 3564.583334 135701.7600 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 2 4.000000 261.0000 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
2828 2703.750000 104932.3500 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 2831 2708.000000 105202.6500 0.0000