CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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 8873 9839.500000 365973.4000 37.1943
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 542 485.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 17131 49171.75000 1828671.7000 37.1895
Subtotal (Total Children Is Unduplicated) 18350 59496.75000 2194645.1000 36.8868
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 3 3.000000 310.0800 103.3600
AACIS-92597TL-AAC INTIAL EVAL BY LICENSED SLP 2 2.000000 206.7200 103.3600
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 17 18.000000 873.0000 48.5000
EXIT-EXIT-COS Exit 121 193.000000 9650.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 68 125.000000 9375.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 42 71.500000 5323.5000 74.4545
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 16 29.500000 2212.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 14 25.000000 1875.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 9 15.000000 1125.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 13 24.500000 1837.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 27 54.500000 4012.5000 73.6239
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 12 22.000000 1650.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 55 102.000000 5700.0000 55.8824
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 41 68.500000 3801.7500 55.5000
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 3 5.000000 277.5000 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 951 1776.500000 132835.6000 74.7738
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 645 1168.000000 87504.0000 74.9178
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 284 523.500000 39096.2000 74.6823
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 389 683.000000 51225.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 295 501.000000 37597.5200 75.0450
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 172 312.000000 23475.0000 75.2404
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1081 1956.000000 108424.9500 55.4320
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 864 1601.500000 89013.0000 55.5810
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 340 650.500000 48700.8000 74.8667
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 280 517.500000 38812.5000 75.0000
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 47 48.000000 5933.7000 123.6188
OCTH-97165TL-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 4 4.000000 205.6400 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 2 2.000000 123.3700 61.6850
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 18 18.000000 1000.0000 55.5556
SPCH-92521-EVAL OF SPEECH FLUENCY 1 1.000000 51.4100 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 6 7.000000 359.8700 51.4100
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 6 6.000000 308.4600 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 13 42.000000 2179.7700 51.8993
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 5 18.000000 925.3800 51.4100
Subtotal (Total Children Is Unduplicated) 3393 10600.00000 716310.6800 67.5765
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 7 7.000000 296.8700 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 14 27.000000 2952.9000 109.3667
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 100 107.250000 5412.5000 50.4662
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 137 144.750000 7237.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 30 28.750000 718.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 103 161.500000 8075.0000 50.0000
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 291 156.250000 7787.5000 49.8400
CONIP-CONIP-CONSULT, ITDS PHONE 2 2.000000 50.0000 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 84 90.750000 4475.0000 49.3113
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 314 176.500000 8750.0000 49.5751
CONOP-CONOP-CONSULT, OT, PHONE 11 7.000000 175.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 108 149.000000 7450.0000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 275 124.250000 6212.5000 50.0000
CONPP-CONPP-CONSULT, PT, PHONE 14 10.000000 250.0000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 128 160.250000 7987.5000 49.8440
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 324 203.750000 10187.5000 50.0000
CONSP-CONSP-CONSULT, SLP, PHONE 14 14.750000 368.7500 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 1057 4117.750000 229.0000 0.0556
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 2 4.000000 100.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 4 4.000000 200.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 647 2542.500000 127125.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 195 481.250000 24074.7000 50.0254
EPIC-99601-Early Steps Professional Development Fee 703 2689.000000 40335.0000 15.0000
INTR-T1013-INTERPRETER 83 353.250000 17662.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 390 1517.000000 18242.0000 12.0250
OCCT-97530-OT SESSION BY LICENSED OT 98 379.770000 27329.6300 71.9636
OCCT-97530GT-OT SESSION BY LICENSED OT 36 62.250000 4479.5100 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 5.000000 288.0000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 111 334.730000 24085.7900 71.9559
OCCT-97530TLGT-OT SESSION BY LICENSED OT 44 113.500000 8131.4800 71.6430
OCCT-97530TLHM-OT SESSION BY OT ASST 4 8.000000 460.8000 57.6000
CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2023 ending 12/31/2023 Date of Report:01/14/2024 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-97110-PT SESSION BY LICENSED PT 103 397.750000 28958.1700 72.8050
PHY-97110GT-PT SESSION BY LICENSED PT 11 10.000000 719.6000 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 118 511.750000 36825.5300 71.9600
PHY-97110TLGT-PT SESSION BY LICENSED PT 28 31.500000 2266.7400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 139 593.360000 42395.5600 71.4500
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 28 67.250000 4839.3100 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 95 331.640000 23863.4800 71.9560
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 29 57.250000 4119.7100 71.9600
TRAV-TRAVS-Travel by mile 306 21803.00000 9700.2300 0.4449
Subtotal (Total Children Is Unduplicated) 2089 37986.25000 524819.0100 13.8160
-----------------------------------------------------------------------------------------------------------------------
Total 108083.000000 3435774.7900 31.7883
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 19290
-----------------------------------------------------------------------------------------------------------------------
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 14 14.000000 966.3400 0.0000
H 866 1127.000000 74967.7100 49656.9700
T 3 4.000000 216.5000 216.5000
425 462.750000 26819.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1309 1608.750000 103020.1500 49873.4700
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 0.0000
0 0.000000 0.0000 0.0000
Other 1105 2507.250000 24787.5700 0.0000
---------------------------------------------------------
Total 1106 2508.250000 24807.5700 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 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
2906 1980.000000 75654.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2906 1980.000000 75654.9000 0.0000
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 89 159.500000 6597.4500 0.0000
U 0 0.000000 0.0000 0.0000
B 1238 2154.000000 84392.2500 0.0000
P 593 997.250000 38641.1000 38420.8300
D 21 37.750000 1404.3000 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
2199 2760.000000 128498.3500 0.0000
Other 14 19.500000 725.4000 0.0000
---------------------------------------------------------
Total 4155 6128.250000 260268.1500 38420.8300
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 18.500000 688.2000 0.0000
U 0 0.000000 0.0000 0.0000
B 2062 1247.750000 46416.3000 23724.3800
P 0 0.000000 0.0000 0.0000
D 7 3.250000 120.9000 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
2476 1272.500000 44072.0000 1133.9000
Other 66 51.750000 1925.1000 0.0000
---------------------------------------------------------
Total 4638 2593.750000 93222.5000 24858.2800
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 1 0.250000 9.3000 0.0000
9481 7047.000000 295737.9400 0.0000
Other 473 279.250000 10378.8000 0.0000
---------------------------------------------------------
Total 9955 7326.500000 306126.0400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 58 36.750000 1367.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 706 597.500000 27861.5000 0.0000
P 1700 1372.697800 61642.3350 61605.1300
D 36 32.000000 1453.8000 0.0000
S 2 0.500000 18.6000 0.0000
H 10 20.000000 1500.0000 0.0000
T 0 0.000000 0.0000 0.0000
5822 3261.302200 123374.1150 0.0000
Other 224 103.750000 3859.5000 0.0000
---------------------------------------------------------
Total 8558 5424.500000 221076.9500 61605.1300
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 5058 5727.500000 206065.7300 206065.7300
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2170 2443.750000 109136.9300 93717.6800
T 0 0.000000 0.0000 0.0000
1072 1166.500000 47324.9000 130.2000
Other 3 3.750000 271.8000 0.0000
---------------------------------------------------------
Total 8303 9341.500000 362799.3600 299913.6100
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 47 32.750000 1218.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 8349 7346.000000 314934.4500 0.0000
P 6 10.500000 748.5000 0.0000
D 15 11.000000 409.2000 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
5613 5124.500000 226478.8500 0.0000
Other 400 291.750000 10965.3000 0.0000
---------------------------------------------------------
Total 14430 12816.500000 554754.6000 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 8 7.000000 388.5000 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
4 4.500000 249.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 12 11.500000 638.2500 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 44 41.250000 2184.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 610 623.500000 32054.2400 109.1600
P 1361 1341.500000 65166.7000 63890.6200
D 83 83.750000 6087.6500 0.0000
S 328 264.250000 10522.2000 180.0200
H 89 110.250000 7993.7000 0.0000
T 2952 21255.500000 59177.2200 50416.4100
2456 2925.000000 56443.1600 272.5300
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7923 26645.000000 239629.5300 114868.7400
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 903.3000 0.0000
U 0 0.000000 0.0000 0.0000
B 454 415.750000 22448.4400 0.0000
P 2332 2162.680000 108623.3300 108430.7300
D 275 236.940000 12974.0400 0.0000
S 121 119.380000 4845.9500 0.0000
H 89 90.500000 6468.9700 0.0000
T 1 0.250000 9.3000 0.0000
8335 5926.500000 168060.6400 0.0000
Other 161 124.000000 5666.1500 203.7000
---------------------------------------------------------
Total 11795 9099.250000 330000.1200 108634.4300
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 27 23.250000 899.6600 0.0000
U 0 0.000000 0.0000 0.0000
B 565 527.250000 24092.0900 0.0000
P 3316 2948.580000 134985.2900 134838.0500
D 289 218.800000 10442.6200 0.0000
S 23 21.390000 1266.5300 0.0000
H 124 129.980000 8939.4600 0.0000
T 1 0.250000 9.3000 0.0000
8277 6413.750000 176587.9400 0.0000
Other 152 124.000000 5645.7200 0.0000
---------------------------------------------------------
Total 12774 10407.250000 362868.6100 134838.0500
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1636 1516.250000 65703.0400 0.0000
P 1092 983.000000 39560.7000 38626.2000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 26 47.500000 3551.8600 0.0000
T 0 0.000000 0.0000 0.0000
4519 3263.000000 126026.2100 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 7273 5809.750000 234841.8100 38626.2000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1532 2266.000000 98783.1000 0.0000
P 12 19.000000 1239.7500 1252.2500
D 6 11.500000 427.8000 0.0000
S 4 5.500000 354.0000 0.0000
H 249 361.750000 13457.1000 13457.1000
T 1 1.500000 83.2500 83.2500
3283 3493.250000 143397.7500 0.0000
Other 215 223.750000 8323.5000 0.0000
---------------------------------------------------------
Total 5302 6382.250000 266066.2500 14792.6000