CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2017 ending 09/30/2017 Date of Report:11/05/2017 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 7.500000 562.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 16 32.000000 2400.0000 75.0000
Subtotal (Total Children Is Unduplicated) 20 39.500000 2962.5000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 81 3466.000000 86650.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 10 41.000000 2050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 5.500000 392.9200 71.4400
PHY-97110-PT SESSION BY LICENSED PT 13 6.500000 464.3600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 18 22.000000 1257.5200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 7.500000 535.8000 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 3 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 91 3550.500000 91378.3600 25.7368
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Total 3590.000000 94340.8600 26.2788
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Number of Children (Unduplicated) With at Least One Service 111
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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
215 3405.000000 87274.7600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 215 3405.000000 87274.7600 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
20 39.500000 2962.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 20 39.500000 2962.5000 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
25 145.500000 4103.6000 4103.6000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 25 145.500000 4103.6000 4103.6000