CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2017 ending 03/31/2017 Date of Report:05/05/2017 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 45.500000 3412.5000 75.0000
Subtotal (Total Children Is Unduplicated) 26 51.500000 3862.5000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 72 5603.000000 140075.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 193.000000 9650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 53 148.750000 10626.7000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 58 158.500000 9066.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 35 59.250000 4232.8200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 44 127.250000 7273.6100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 62 109.250000 7804.8200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 87 242.500000 13871.0000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 10 7.000000 97.1600 13.8800
Subtotal (Total Children Is Unduplicated) 199 6648.500000 202697.3100 30.4877
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Total 6700.000000 206559.8100 30.8298
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Number of Children (Unduplicated) With at Least One Service 225
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Center 04
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
324 5647.750000 148994.9000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 324 5647.750000 148994.9000 0.0000
Center 06
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 1.500000 107.1600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 3 1.500000 107.1600 0.0000
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
26 51.500000 3862.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 26 51.500000 3862.5000 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
515 999.250000 53595.2500 53595.2500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 515 999.250000 53595.2500 53595.2500