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
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 27510 57227.75000 2125248.7500 37.1367
SCTT-SCTT-SERVICE COORDINATOR TRAVEL 2132 2299.000000 0.0000 0.0000
TCM-T1017TL-TARGETED CASE MANAGEMENT 18779 99633.08410 3699453.5785 37.1308
Subtotal (Total Children Is Unduplicated) 35043 159159.8341 5824702.3285 36.5966
-----------------------------------------------------------------------------------------------------------------------
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 124 196.000000 9800.0000 50.0000
EVAL-96111GT-DEVELOPMENTAL EVALUATION 30 60.000000 3000.0000 50.0000
EXIT-EXIT-EXIT ASSESSMENT 979 1484.147400 74207.3700 50.0000
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 19 32.000000 2400.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 35 64.500000 4837.5000 75.0000
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 2 2.500000 187.5000 75.0000
IPDEF-T1024GOTSGT-F/U PHYC AND DEV EVAL BY OT 27 49.000000 3675.0000 75.0000
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 4 8.000000 600.0000 75.0000
IPDEF-T1024GPTSGT-F/U PHYC AND DEV EVAL BY PT 7 12.500000 937.5000 75.0000
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 18 32.500000 2437.5000 75.0000
IPDEF-T1024TLTSGT-F/U PHYC AND DEV EVAL BY EI PROF 13 20.000000 1490.2500 74.5125
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 26 45.000000 2497.5000 55.5000
IPDEF-T1024TSGT-F/U PHYC AND DEV EVAL BY ITDS 71 124.500000 6909.7500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 359 606.235394 44249.0550 72.9899
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 529 921.042899 69028.2175 74.9457
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 76 124.670133 9275.2600 74.3984
IPDEI-T1024GOUKGT-INITIAL PSYCH AND DEV EVAL BY OT 303 518.500000 38848.5000 74.9248
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 91 158.738600 11876.1450 74.8157
IPDEI-T1024GPUKGT-INITIAL PSYCH AND DEV EVAL BY PT 134 244.754900 18319.1175 74.8468
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 803 1501.356216 83242.0200 55.4446
IPDEI-T1024HNUKGT-INITIAL PSYCH AND DEV EVAL BY ITDS 1181 2044.000000 113392.0000 55.4755
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 302 502.903600 37717.7700 75.0000
IPDEI-T1024TLGT-INITIAL PSYCH AND DEV EVAL BY EI PROF 193 321.504900 24083.6175 74.9090
MED-99203-OUTPATIENT VISIT, NEW, 30 MINS 78 78.000000 5820.1400 74.6172
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 2 3.000000 148.9100 49.6367
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 3 3.000000 154.2300 51.4100
SCREEN-T1023-SCREENING 51 52.000000 2600.0000 50.0000
SPCH-92521-EVAL OF SPEECH FLUENCY 5 6.000000 307.7400 51.2900
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 8.000000 411.2800 51.4100
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 16 18.000000 924.3000 51.3500
Subtotal (Total Children Is Unduplicated) 3951 9330.354042 577802.0825 61.9271
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 32 75.000000 5428.6000 72.3813
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 428 488.000000 24400.0000 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 525 783.750000 39162.5000 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 2414 11923.49970 0.0000 0.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 17 92.500000 4625.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 192 1234.500000 61582.8000 49.8848
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 97 410.250000 20512.5000 50.0000
INTR-T1013-INTERPRETER 337 1791.750000 89587.5000 50.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 2026 18125.00000 181250.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 55 372.500000 26760.3800 71.8399
OCCT-97530GT-OT SESSION BY LICENSED OT 29 128.000000 9203.2100 71.9001
OCCT-97530HM-OT SESSION BY OT ASST 2 4.000000 230.4000 57.6000
OCCT-97530TL-OT SESSION BY LICENSED OT 13 37.500000 2683.9400 71.5717
OCCT-97530TLGT-OT SESSION BY LICENSED OT 6 9.500000 682.5800 71.8505
PHY-97110-PT SESSION BY LICENSED PT 41 290.790000 20890.4100 71.8402
PHY-97110GT-PT SESSION BY LICENSED PT 13 27.250000 1957.4000 71.8312
PHY-97110TL-PT SESSION BY LICENSED PT 10 37.000000 2656.8000 71.8054
PHY-97110TLGT-PT SESSION BY LICENSED PT 3 2.250000 161.9100 71.9600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 86 614.965033 43939.5100 71.4504
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 45 202.750000 14570.2600 71.8632
SPL-92507TL-SPL THERAPY SESSION BY LICENSED SLP 20 79.000000 5677.0400 71.8613
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 13 40.500000 2905.2800 71.7353
TELEC-TELEC-TELECONFERENCE,PROVIDER TO FAMILY,PHONE 171 268.500000 9934.5000 37.0000
TRAV-TRAVS-Travel by mile 896 95609.00000 42539.1900 0.4449
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
Payclass Filters:GR
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Subtotal (Total Children Is Unduplicated) 4885 138374.0047 891042.7100 6.4394
-----------------------------------------------------------------------------------------------------------------------
Total 306864.192875 7293547.1210 23.7680
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 35848
-----------------------------------------------------------------------------------------------------------------------
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 2 1.250000 59.3000 0.0000
S 54 22.250000 826.6500 0.0000
H 1 0.250000 9.3000 9.3000
T 5 5.000000 90.0000 90.0000
14886 9547.500000 376785.6400 10388.1000
Other 21 9.000000 334.6000 0.0000
---------------------------------------------------------
Total 14969 9585.250000 378105.4900 10487.4000
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 10828 32841.000000 200380.1300 0.0000
---------------------------------------------------------
Total 10829 32841.500000 200398.7300 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 2 3.000000 161.0000 161.0000
T 0 0.000000 0.0000 0.0000
12613 8104.500000 307948.7000 0.0000
Other 3 3.500000 170.4500 0.0000
---------------------------------------------------------
Total 12618 8111.000000 308280.1500 161.0000
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 5 3.000000 129.7000 167.0000
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 9.2500 0.0000
11760 12424.500000 501220.0400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 11766 12427.750000 501358.9900 167.0000
Center 05
Flag Claims Units Chgs Paid
---------------------------------------------------------
R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 2 0.500000 18.6000 18.6000
P 1 29.000000 12.9000 12.9000
D 30 21.250000 789.3500 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
11755 6169.250000 212822.3000 0.0000
Other 1 0.250000 9.3000 0.0000
---------------------------------------------------------
Total 11789 6220.250000 213652.4500 31.5000
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
19349 11582.750000 440295.5900 0.0000
Other 771 485.250000 19103.0000 0.0000
---------------------------------------------------------
Total 20122 12072.000000 459659.5900 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 2 1.250000 19.3000 10.0000
D 29 27.500000 1399.0000 0.0000
S 1 0.250000 9.3000 0.0000
H 2 4.000000 300.0000 0.0000
T 0 0.000000 0.0000 0.0000
25683 13291.853700 483972.8710 0.0000
Other 1 2.000000 74.4000 0.0000
---------------------------------------------------------
Total 25718 13326.853700 485774.8710 10.0000
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 37813 36596.500000 1414324.8600 1414315.5600
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 3098 3172.250000 123694.5300 123694.5300
66 65.750000 2687.8600 0.0000
Other 5 8.000000 511.0000 0.0000
---------------------------------------------------------
Total 40982 39842.500000 1541218.2500 1538010.0900
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 1 0.750000 37.5000 37.5000
D 0 0.000000 0.0000 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
20853 16960.000000 668103.8000 0.0000
Other 4 2.500000 93.0000 0.0000
---------------------------------------------------------
Total 20859 16963.750000 668252.9000 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 0 0.000000 0.0000 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
27 38.500000 2205.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28 40.500000 2302.5000 97.5000
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 2 0.500000 18.5500 18.5500
D 72 86.500000 4586.6000 0.0000
S 24 13.000000 576.0000 0.0000
H 1 3.000000 111.0000 0.0000
T 5808 73214.750000 108322.9300 103325.9600
8422 5217.750000 153673.3500 93.4000
Other 5 6.000000 222.6000 0.0000
---------------------------------------------------------
Total 14334 78541.500000 267511.0300 103437.9100
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 1274 854.500000 38510.8300 0.0000
S 454 293.250000 8846.5000 0.0000
H 1 0.250000 12.5000 0.0000
T 0 0.000000 0.0000 0.0000
35311 23554.000000 560728.6400 0.0000
Other 126 102.750000 3961.7600 0.0000
---------------------------------------------------------
Total 37166 24804.750000 612060.2300 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 866 631.540000 28984.7200 0.0000
S 8 7.750000 40.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
36127 25878.500000 643935.2400 0.0000
Other 199 136.250000 5060.4500 0.0000
---------------------------------------------------------
Total 37200 26654.040000 678020.4100 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 1 0.500000 18.6000 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
19352 12844.049175 488141.6300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 19353 12844.549175 488160.2300 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 1 2.000000 150.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 15 20.000000 854.6500 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
12653 12564.000000 487712.2500 0.0000
Other 2 1.500000 55.8000 0.0000
---------------------------------------------------------
Total 12671 12587.500000 488772.7000 0.0000