CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 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 26 52.000000 3900.0000 75.0000
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) 35 65.000000 4755.2500 73.1577
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 83 6058.000000 151450.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 16 205.000000 10250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 16 41.500000 2964.7600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 22 53.500000 3060.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 28 37.000000 2643.2800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 40 126.250000 7216.4500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 47 105.000000 7501.2000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 22 41.000000 2345.2000 57.2000
Subtotal (Total Children Is Unduplicated) 129 6667.250000 187431.0900 28.1122
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Total 6732.250000 192186.3400 28.5471
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Number of Children (Unduplicated) With at Least One Service 159
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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
370 5889.750000 156188.1500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 370 5889.750000 156188.1500 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
30 60.000000 4500.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 30 60.000000 4500.0000 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
178 782.500000 31498.1900 31482.8600
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 178 782.500000 31498.1900 31482.8600