CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
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
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 51.0500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF
VOICE AND RES 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 5 5.000000 255.2500 51.0500
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 15 498.000000 12450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 113.000000 5650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 10 29.500000 2107.4800 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 22 53.500000 3060.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 6 14.500000 1035.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 13 39.500000 2257.8200 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 56.500000 4036.3600 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 22 41.000000 2345.2000 57.2000
Subtotal (Total Children Is Unduplicated) 53 845.500000 32942.9400 38.9627
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Total 850.500000 33198.1900 39.0337
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Number of Children (Unduplicated) With at Least One Service 53
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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
179 850.500000 33198.1900 33182.8600
Other 0 0.000000 0.0000 0.0000
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Total 179 850.500000 33198.1900 33182.8600