CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 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 27511 57238.25000 2125639.2000 37.1367
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2133 2299.500000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 43508 267838.0613 9945138.9885 37.1312
Subtotal (Total Children Is Unduplicated) 45282 327375.8113 12070778.1885 36.8713
-----------------------------------------------------------------------------------------------------------------------
Screening, Eval, and Assessment,Class #02
ASTE-ASTE-ASSISTIVE TECHNOLOGY EVAL 73 85.000000 4122.5000 48.5000
BEHV-BEHV-BEHAVIORAL ASSESSMENT 1 2.000000 250.0000 125.0000
EVAL-96111-DEVELOPMENTAL EVALUATION 129 204.500000 10225.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 32 63.500000 3175.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 988 1499.000000 74950.0000 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 148 278.000000 20196.5200 72.6494
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 201 358.500000 26780.6800 74.7020
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 39 70.500000 5287.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 132 233.000000 17475.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 40 73.000000 5475.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 67 125.500000 9412.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 82 162.000000 12140.2500 74.9398
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 58 97.000000 7245.7500 74.6985
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 153 282.000000 15623.2500 55.4016
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 332 596.500000 33056.6100 55.4176
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 2782 5202.961292 385249.2475 74.0442
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3847 6903.999998 516536.4200 74.8170
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 779 1376.999999 103162.5000 74.9183
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 2257 4037.000000 302091.9000 74.8308
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 859 1619.000300 121225.7725 74.8769
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 1245 2361.000000 176270.3100 74.6592
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 3647 6826.999998 378626.7500 55.4602
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 6172 11313.50000 626876.2000 55.4096
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 1800 3230.000000 242137.5000 74.9652
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 1296 2320.584600 173872.8400 74.9263
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 314 315.000000 41605.8300 132.0820
MED-99213-OUTPATIENT VISIT, EST, 15 MINS 6 6.000000 350.0500 58.3417
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 6 7.000000 354.5500 50.6500
OCTH-97165TL-OT EVAL LOW COMPLEXITY 2 2.000000 102.8200 51.4100
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.4100 51.4100
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97166TLGT-OT EVAL MODERATE COMPLEXITY 6 6.000000 308.4600 51.4100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SCREEN-T1023-SCREENING 171 175.000000 8704.0000 49.7371
SPCH-92521-EVAL OF SPEECH FLUENCY 11 12.000000 616.2000 51.3500
SPCH-92521TL-EVAL OF SPEECH FLUENCY 3 4.000000 205.6400 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 43 51.000000 2507.7600 49.1718
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 20 22.000000 1129.5800 51.3445
SPCH-92523TL-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 22 23.000000 1182.0700 51.3943
SPCH-92523TLGT-EVAL OF SPCH SOUND PROD; EVAL LANG COM 7 9.000000 462.6900 51.4100
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 44.8600 44.8600
SPL-92526-TREATMENT OF SWALLOWING DYSFUNCTION 16 84.000000 3973.1000 47.2988
SPL-92526TL-TREATMENT OF SWALLOWING DYSFUNCTION 15 93.000000 4913.6100 52.8345
Subtotal (Total Children Is Unduplicated) 16104 50142.04619 3338440.3200 66.5797
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 54 133.000000 9594.4800 72.1389
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 429 489.250000 24462.5000 50.0000
COIFF-COIFFGT-IFSP CONSULT, PROF, TELEMEDICINE 604 754.750000 37737.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 161 158.750000 3968.7500 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 376 497.750000 24875.0000 49.9749
CONIF-CONIFGT-CONSULT, ITDS, TELEMEDICINE 1197 1040.250000 51938.5000 49.9289
CONIP-CONIP-CONSULT, ITDS PHONE 23 19.750000 493.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 239 313.000000 15650.0000 50.0000
CONOF-CONOFGT-CONSULT, OT, TELEMEDICINE 1158 882.250000 44000.0000 49.8725
CONOP-CONOP-CONSULT, OT, PHONE 20 18.000000 450.0000 25.0000
CONPF-CONPF-CONSULT, PT, FACE TO FACE 251 442.750000 22137.5000 50.0000
CONPF-CONPFGT-CONSULT, PT, TELEMEDICINE 1176 741.500000 37025.0000 49.9326
CONPP-CONPP-CONSULT, PT, PHONE 19 14.500000 362.5000 25.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 525 784.750000 39212.5000 49.9681
CONSF-CONSFGT-CONSULT, SLP, TELEMEDICINE 1108 800.500000 40000.0000 49.9688
CONSP-CONSP-CONSULT, SLP, PHONE 46 42.500000 1062.5000 25.0000
DSTT-DSTT-DIRECT SERVICE COORDINATOR TRAVEL 2415 11937.24970 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 28 105.000000 5212.5000 49.6429
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1269 11107.75000 551251.5500 49.6277
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 727 3223.750000 161156.0000 49.9902
INTR-T1013-INTERPRETER 337 1791.750000 89587.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2026 18131.00000 181300.0000 9.9994
OCCT-97530-OT SESSION BY LICENSED OT 187 1361.250000 98725.8200 72.5259
OCCT-97530GT-OT SESSION BY LICENSED OT 103 367.000000 26807.2700 73.0443
OCCT-97530HM-OT SESSION BY OT ASST 3 24.000000 968.5200 40.3550
CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2022 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
OCCT-97530TL-OT SESSION BY LICENSED OT 179 1319.750000 94709.9300 71.7635
OCCT-97530TLGT-OT SESSION BY LICENSED OT 118 458.750000 32959.1300 71.8455
OCCT-97530TLGTHM-OT SESSION BY OT ASST 1 1.000000 57.6000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 186 1670.120000 122553.4900 73.3801
PHY-97110GT-PT SESSION BY LICENSED PT 60 129.380000 9290.7800 71.8100
PHY-97110TL-PT SESSION BY LICENSED PT 228 2158.250000 155040.4200 71.8362
PHY-97110TLGT-PT SESSION BY LICENSED PT 86 165.250000 11862.9200 71.7877
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 367 3238.685504 229071.0500 70.7296
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 152 498.000000 36129.8100 72.5498
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 265 2205.910000 158352.0300 71.7854
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 130 529.250000 38025.2900 71.8475
SPL-92508TLGT-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 27.9200 13.9600
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 171 268.500000 9934.5000 37.0000
TRAV-TRAVS-Travel by mile 896 95628.00000 42544.5300 0.4449
Subtotal (Total Children Is Unduplicated) 5220 163454.8452 2408539.0400 14.7352
-----------------------------------------------------------------------------------------------------------------------
Total 540972.702643 17817757.5485 32.9365
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 45591
-----------------------------------------------------------------------------------------------------------------------
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 1.500000 68.6000 0.0000
S 56 25.250000 987.6500 0.0000
H 29555 21090.750000 933699.0800 830739.8700
T 6 6.250000 136.5000 90.0000
15803 10464.000000 432097.0900 16647.0000
Other 348 159.500000 6890.1500 0.0000
---------------------------------------------------------
Total 45771 31747.250000 1373879.0700 847476.8700
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 16266 36874.750000 373307.0300 0.0000
---------------------------------------------------------
Total 16267 36875.250000 373325.6300 0.0000
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 103 139.500000 5189.4000 0.0000
U 0 0.000000 0.0000 0.0000
B 5852 3847.500000 148370.7400 0.0000
P 2780 1867.000000 73440.5500 73364.4800
D 77 76.000000 3323.8500 0.0000
S 0 0.000000 0.0000 0.0000
H 4 6.500000 423.5000 423.5000
T 0 0.000000 0.0000 0.0000
14453 9523.000000 366492.4800 0.0000
Other 241 228.750000 8792.2500 0.0000
---------------------------------------------------------
Total 23510 15688.250000 606032.7700 73787.9800
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 174 297.250000 11590.0500 0.0000
U 0 0.000000 0.0000 0.0000
B 5393 8198.000000 324988.9500 0.0000
P 6338 10344.250000 420632.0000 425522.9700
D 930 1345.250000 51793.4500 0.0000
S 4 5.000000 186.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 2 3.250000 120.2500 0.0000
13401 14227.250000 630047.1800 0.0000
Other 2 6.250000 232.5000 0.0000
---------------------------------------------------------
Total 26244 34426.500000 1439590.3800 425522.9700
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 33 15.000000 558.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 11421 6901.250000 256355.9000 210435.1500
P 1 29.000000 12.9000 12.9000
D 95 53.750000 1992.5000 83.2500
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
11770 6177.750000 213138.5000 0.0000
Other 38 27.750000 1032.3000 0.0000
---------------------------------------------------------
Total 23358 13204.500000 473090.1000 210531.3000
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
41716 30420.500000 1281683.6400 0.0000
Other 776 491.500000 19447.7000 0.0000
---------------------------------------------------------
Total 42494 30916.000000 1301392.3400 0.0000
Center 07
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 86 68.250000 2990.1000 0.0000
U 0 0.000000 0.0000 0.0000
B 1855 1514.000000 68777.4000 0.0000
P 9474 7903.647000 345395.7300 345124.3900
D 216 182.749300 9300.7975 0.0000
S 1 0.250000 9.3000 0.0000
H 102 204.000000 15300.0000 0.0000
T 0 0.000000 0.0000 0.0000
25819 13512.853700 499005.5710 0.0000
Other 1397 697.500000 26777.2000 -150.0000
---------------------------------------------------------
Total 38950 24083.250000 967556.0985 344974.3900
Center 09
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 189 187.000000 7335.6400 0.0000
U 0 0.000000 0.0000 0.0000
B 8238 8736.500000 352460.2300 5350.7100
P 46329 45776.500000 1786318.3000 1786153.7500
D 4 6.500000 241.8000 0.0000
S 1 2.000000 102.8200 51.0500
H 889 1263.500000 70762.1500 0.0000
T 3124 3201.750000 125281.8800 125281.2800
432 611.750000 31489.4500 288.0000
Other 22 31.250000 1576.1000 0.0000
---------------------------------------------------------
Total 59228 59816.750000 2375568.3700 1917124.7900
Center 10
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 82 73.250000 2893.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 37544 32355.500000 1353898.2000 0.0000
P 186 225.750000 12123.1500 37.5000
D 451 566.750000 34453.6500 0.0000
S 1 0.500000 18.6000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
24228 21192.250000 928090.1000 0.0000
Other 526 369.500000 13923.4500 0.0000
---------------------------------------------------------
Total 63018 54783.500000 2345400.9500 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 36 49.500000 3119.2500 0.0000
P 1 2.000000 97.5000 97.5000
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
83 116.000000 6564.7500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 120 167.500000 9781.5000 97.5000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 11 8.750000 451.9200 0.0000
U 0 0.000000 0.0000 0.0000
B 1857 1867.500000 101343.0200 55.8000
P 7056 7465.750000 351968.8600 463334.3400
D 1109 1250.750000 67720.7300 2103.2000
S 542 471.750000 20740.0500 2168.4000
H 403 519.000000 33846.1800 0.0000
T 7755 75332.750000 225130.8300 186128.6900
8719 5561.500000 171011.2900 513.9400
Other 6 8.000000 372.6000 150.0000
---------------------------------------------------------
Total 27458 92485.750000 972585.4800 654454.3700
Center 53
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 181 181.000000 12678.3100 0.0000
U 0 0.000000 0.0000 0.0000
B 1258 1128.750000 56195.6600 0.0000
P 11242 10328.066440 523484.2900 520871.6800
D 2097 1701.033560 89555.7600 0.0000
S 627 470.500000 17909.9000 0.0000
H 464 494.900000 35254.3300 0.0000
T 0 0.000000 0.0000 0.0000
36299 24591.750000 631067.6200 359.8000
Other 732 608.000000 29705.1800 145.8900
---------------------------------------------------------
Total 52900 39504.000000 1395851.0500 521377.3700
Center 54
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 12 14.000000 520.8000 0.0000
U 0 0.000000 0.0000 0.0000
B 2268 2096.000000 99920.9600 0.0000
P 18846 16863.450000 784833.7000 784289.7400
D 1520 1319.870000 71888.7300 0.0000
S 40 36.610000 1812.6700 37.2000
H 471 520.310000 37330.6500 0.0000
T 0 0.000000 0.0000 0.0000
37237 27100.000000 727797.3600 0.0000
Other 570 466.190000 22806.7800 1550.8300
---------------------------------------------------------
Total 60964 48416.430000 1746911.6500 785877.7700
Center 55
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 3497 3293.750000 148008.8000 0.0000
P 9374 8683.416666 358797.9500 358447.7400
D 1 0.250000 9.3000 0.0000
S 10 12.913867 892.5400 37.5000
H 141 214.165509 15528.5900 0.0000
T 0 0.000000 0.0000 0.0000
19935 13432.549449 524207.5200 0.0000
Other 1 0.250000 9.3000 9.3000
---------------------------------------------------------
Total 32959 25637.295491 1047454.0000 358494.5400
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 19 32.750000 1442.7000 0.0000
U 0 0.000000 0.0000 0.0000
B 4238 5959.250000 257312.3000 139.5000
P 8937 12812.477152 538705.6000 542726.4060
D 136 245.250000 15534.7500 92.5000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 145 222.500000 10665.9000 7674.2000
13195 13572.000000 551695.1600 329.4000
Other 410 375.750000 13963.1500 0.0000
---------------------------------------------------------
Total 27080 33219.977152 1389319.5600 550962.0060