CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2016 ending 03/31/2016 Date of Report:05/12/2016 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
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
AUDE-92585-AUD EVOKED RESPONSE (COMP) 1 1.000000 65.1400 65.1400
NUTR-97803-NUTRITIONAL EVAL, FOLLOW-UP 12 52.000000 2600.0000 50.0000
OCTH-97003-OT EVAL BY LICENSED OT, INITIAL 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 16 56.000000 2818.2900 50.3266
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 26 30.750000 1537.5000 50.0000
COIFP-COIFP-IFSP CONSULT, PROF, BY PHONE 9 7.500000 187.5000 25.0000
CONIF-CONIF-CONSULT, ITDS FACE TO FACE 52 53.000000 2650.0000 50.0000
CONIP-CONIP-CONSULT, ITDS PHONE 25 37.750000 943.7500 25.0000
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 3 3.000000 150.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 87 343.000000 17120.0000 49.9125
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 19 37.000000 370.0000 10.0000
OCCT-97530-OT SESSION BY LICENSED OT 19 78.500000 5608.0400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 2 15.000000 858.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 42 204.750000 14627.3400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 3 4.500000 257.2200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 154 677.500000 48353.5400 71.3705
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 104.8800 52.4400
TRAV-TRAVS-Travel by mile 418 20942.00000 9282.6300 0.4433
Subtotal (Total Children Is Unduplicated) 487 22437.25000 102100.4000 4.5505
-----------------------------------------------------------------------------------------------------------------------
Total 22493.250000 104918.6900 4.6645
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 488
-----------------------------------------------------------------------------------------------------------------------
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 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 71.4400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 71.4400 0.0000
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 981 19317.500000 71364.8200 71364.8200
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
176 2963.500000 21186.6200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1157 22281.000000 92551.4400 71364.8200
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 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
3 15.000000 1050.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 15.000000 1050.1600 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 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
138 136.000000 9424.7300 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 138 136.000000 9424.7300 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 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
0 0.000000 0.0000 0.0000
Other 35 60.250000 1820.9200 1820.9200
---------------------------------------------------------
Total 35 60.250000 1820.9200 1820.9200