CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2016 ending 12/31/2016 Date of Report:02/04/2017 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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 51.0500 51.0500
PSTH-97001-EVAL BY LICENSED PT, INITIAL 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 8 8.000000 408.4000 51.0500
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 991 8876.750000 443837.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 34 233.500000 16681.2400 71.4400
PHY-97110-PT SESSION BY LICENSED PT 35 276.000000 19717.4400 71.4400
PHY-97110HM-PT SESSION BY PT ASST 2 5.500000 314.3800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 32 176.500000 12609.1600 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 3.000000 41.6400 13.8800
Subtotal (Total Children Is Unduplicated) 1039 9571.250000 493201.3600 51.5295
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Total 9579.250000 493609.7600 51.5291
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Number of Children (Unduplicated) With at Least One Service 1039
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Center 10
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
2857 9579.250000 493609.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2857 9579.250000 493609.7600 0.0000