CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2013 ending 06/30/2013 Date of Report:08/18/2013 Page: 1
List order: No List
Agency Filter:EXT
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
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 1 1.000000 48.5000 48.5000
PSTF-97002-EVAL BY LICENSED PT, FOLLOW-UP 1 1.000000 48.5000 48.5000
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 48.5000 48.5000
Subtotal (Total Children Is Unduplicated) 2 3.000000 145.5000 48.5000
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EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 1 188.000000 4700.0000 25.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 72 2338.000000 58450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 225.000000 11250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 196.500000 13338.4200 67.8800
OCCT-97530HM-OT SESSION BY OT ASST 1 2.000000 108.6400 54.3200
PHY-97110-PT SESSION BY LICENSED PT 46 150.500000 10215.9400 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 249.000000 16902.1200 67.8800
Subtotal (Total Children Is Unduplicated) 118 3349.000000 114965.1200 34.3282
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Total 3352.000000 115110.6200 34.3409
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Number of Children (Unduplicated) With at Least One Service 118
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Center 04
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
316 2270.500000 69712.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 316 2270.500000 69712.8800 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
222 1081.500000 45397.7400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 222 1081.500000 45397.7400 0.0000