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
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 8870 9838.250000 365926.9000 37.1943
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 542 485.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 7306 19737.25000 733966.2500 37.1869
Subtotal (Total Children Is Unduplicated) 12884 30061.00000 1099893.1500 36.5887
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Screening, Eval, and Assessment,Class #02
AACIS-92597-AAC INTIAL EVAL BY LICENSED SLP 1 1.000000 103.3600 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 13 22.612800 1695.9600 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 9 14.000000 1050.0000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 1 2.000000 150.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 1 2.000000 150.0000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 7 14.000000 1050.0000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 2 4.500000 337.5000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 12 23.500000 1304.2500 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 10 16.500000 915.7500 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 128 231.146533 17335.9900 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 99 167.500000 12533.2500 74.8254
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 31 57.000000 4275.0000 75.0000
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 71 122.120000 9159.0000 75.0000
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 32 51.400200 3855.0150 75.0000
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 20 35.500000 2662.5000 75.0000
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 198 367.000000 20368.5000 55.5000
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 174 314.500000 17493.7500 55.6240
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 54 96.532000 7314.9000 75.7769
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 43 74.000000 5550.0000 75.0000
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 2 2.000000 102.8200 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 3.000000 154.2300 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.4100 51.4100
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 2 7.000000 380.4200 54.3457
Subtotal (Total Children Is Unduplicated) 736 1846.811533 118840.0150 64.3488
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EI Services,Class #03
AACFIT-92609-AAC FITTING, ADJUST, TRAINING VISIT 4 4.000000 169.6400 42.4100
ASST-ASST-ASSISTIVE TECHNOLOGY 8 13.000000 1945.4600 149.6508
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 100 107.250000 5412.5000 50.4662
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 136 143.750000 7187.5000 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 83 89.750000 4425.0000 49.3036
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 107 148.000000 7400.0000 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 1054 4109.250000 229.0000 0.0557
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 94 335.750000 16787.5000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 28 65.750000 3287.5000 50.0000
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 1516.000000 18230.0000 12.0251
OCCT-97530-OT SESSION BY LICENSED OT 30 102.000000 7339.9200 71.9600
OCCT-97530GT-OT SESSION BY LICENSED OT 9 12.750000 917.4900 71.9600
OCCT-97530TL-OT SESSION BY LICENSED OT 4 7.000000 503.7200 71.9600
PHY-97110-PT SESSION BY LICENSED PT 12 48.250000 3472.0700 71.9600
PHY-97110TL-PT SESSION BY LICENSED PT 4 19.000000 1367.2400 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 29 107.750000 7753.6900 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 8 29.000000 2086.8400 71.9600
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 2 4.000000 287.8400 71.9600
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 1.000000 71.9600 71.9600
TRAV-TRAVS-Travel by mile 305 21734.00000 9669.5400 0.4449
Subtotal (Total Children Is Unduplicated) 1928 32685.50000 207154.4100 6.3378
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Total 64593.311533 1425887.5750 22.0748
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Number of Children (Unduplicated) With at Least One Service 13639
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 3 4.000000 216.5000 216.5000
308 324.250000 18012.9700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 311 328.250000 18229.4700 216.5000
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 1.000000 20.0000 0.0000
0 0.000000 0.0000 0.0000
Other 700 2213.500000 12176.9100 0.0000
---------------------------------------------------------
Total 701 2214.500000 12196.9100 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
1303 850.250000 32420.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1303 850.250000 32420.0000 0.0000
Center 04
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
1774 2213.500000 89896.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1774 2213.500000 89896.0000 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 6 3.000000 111.6000 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
2476 1272.500000 44072.0000 1133.9000
Other 1 0.750000 27.9000 0.0000
---------------------------------------------------------
Total 2483 1276.250000 44211.5000 1133.9000
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
4452 2651.750000 100474.1700 0.0000
Other 449 264.500000 9830.1000 0.0000
---------------------------------------------------------
Total 4902 2916.500000 110313.5700 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 33 26.000000 1003.8000 0.0000
S 2 0.500000 18.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
5729 3094.552200 111274.2150 0.0000
Other 1 0.500000 18.6000 0.0000
---------------------------------------------------------
Total 5765 3121.552200 112315.2150 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 4994 5665.250000 203494.6300 203494.6300
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
711 706.750000 26329.6500 0.0000
Other 2 3.500000 262.5000 0.0000
---------------------------------------------------------
Total 5707 6375.500000 230086.7800 203494.6300
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 1 0.250000 9.3000 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
4950 4165.250000 164842.0500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4951 4165.500000 164851.3500 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 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
2 2.500000 138.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 2 2.500000 138.7500 0.0000
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 0 0.000000 0.0000 0.0000
D 7 9.000000 637.2000 0.0000
S 142 83.000000 2966.7000 0.0000
H 0 0.000000 0.0000 0.0000
T 2514 20793.250000 33493.7600 31774.5600
2142 2535.500000 39606.6000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4805 23420.750000 76704.2600 31774.5600
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 1 0.250000 9.3000 0.0000
P 0 0.000000 0.0000 0.0000
D 139 98.750000 4166.1700 0.0000
S 11 5.750000 248.6600 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.3000 0.0000
8008 5611.000000 148361.7000 0.0000
Other 20 13.250000 577.0500 0.0000
---------------------------------------------------------
Total 8180 5729.250000 153372.1800 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 228 156.000000 6275.6400 0.0000
S 4 3.250000 24.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 1 0.250000 9.3000 0.0000
7955 6066.000000 153742.2800 0.0000
Other 42 33.750000 1255.5000 0.0000
---------------------------------------------------------
Total 8230 6259.250000 161306.7200 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 2 0.500000 18.6000 0.0000
P 1 0.500000 18.6000 18.6000
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
4486 3214.259333 122673.5200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4489 3215.259333 122710.7200 18.6000
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 6 11.500000 427.8000 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
2608 2489.000000 96557.5500 0.0000
Other 1 4.000000 148.8000 0.0000
---------------------------------------------------------
Total 2615 2504.500000 97134.1500 0.0000