CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2017 ending 06/30/2017 Date of Report:08/05/2017 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 4 8.000000 600.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 25 50.000000 3750.0000 75.0000
Subtotal (Total Children Is Unduplicated) 29 58.000000 4350.0000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 58 4214.000000 105350.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 140.000000 7000.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 16.750000 1196.6200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 27 39.500000 2821.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 11 16.000000 914.5600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 18 37.750000 2696.8600 71.4400
Subtotal (Total Children Is Unduplicated) 72 4464.000000 119979.9200 26.8772
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Total 4522.000000 124329.9200 27.4945
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Number of Children (Unduplicated) With at Least One Service 101
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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
244 4087.500000 107754.7200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 244 4087.500000 107754.7200 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
29 58.000000 4350.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 29 58.000000 4350.0000 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
59 376.500000 12225.2000 12225.2000
Other 0 0.000000 0.0000 0.0000
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Total 59 376.500000 12225.2000 12225.2000