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
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 79 5966.000000 149150.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 174.000000 8700.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 32 73.000000 5215.1200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 45 90.750000 5190.9000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 32 36.500000 2607.5600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 25 95.000000 5430.2000 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 72 142.000000 10144.4800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 60 145.500000 8322.6000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 8 4.000000 55.5200 13.8800
Subtotal (Total Children Is Unduplicated) 167 6726.750000 194816.3800 28.9614
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Total 6727.750000 194867.4300 28.9647
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Number of Children (Unduplicated) With at Least One Service 167
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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
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
380 1165.000000 49037.9200 49037.9200
Other 0 0.000000 0.0000 0.0000
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Total 380 1165.000000 49037.9200 49037.9200