CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
OCTF-97004-OT EVAL BY LICENSED OT, FOLLOW-UP 4 4.000000 194.0000 48.5000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 2 2.000000 97.0000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 3.000000 145.5000 48.5000
Subtotal (Total Children Is Unduplicated) 9 11.000000 533.5000 48.5000
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EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 4 632.000000 15800.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 102 3840.000000 96000.0000 25.0000
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 1 5.000000 250.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 19 295.000000 14750.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 63 432.750000 29375.0700 67.8800
PHY-97110-PT SESSION BY LICENSED PT 73 348.750000 23673.1500 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 108 595.000000 40388.6000 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 26.4000 13.2000
Subtotal (Total Children Is Unduplicated) 179 6150.500000 220263.2200 35.8122
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Total 6161.500000 220796.7200 35.8349
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Number of Children (Unduplicated) With at Least One Service 179
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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
547 4125.000000 127689.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 547 4125.000000 127689.0600 0.0000
Center 57
Flag Claims Units Chgs Paid
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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
433 2036.500000 93107.6600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 433 2036.500000 93107.6600 0.0000