CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 1 1.000000 51.0500 51.0500
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 64 5371.000000 134275.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 91.000000 4550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 8.500000 607.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 21 22.250000 1589.5400 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 25 66.000000 4715.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 6 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 68 5561.750000 145778.4600 26.2109
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Total 5562.750000 145829.5100 26.2154
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Number of Children (Unduplicated) With at Least One Service 68
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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
289 5562.750000 145829.5100 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 289 5562.750000 145829.5100 0.0000