CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 8 16.000000 1200.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 54.000000 4050.0000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 36 71.000000 5301.0500 74.6627
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 76 5844.000000 146100.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 164.000000 8150.0000 49.6951
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 59 197.750000 14127.2600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 85 367.500000 21021.0000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 38 99.000000 7072.5600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 75 358.500000 20491.8600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 302.000000 21574.8800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 97 338.500000 19362.2000 57.2000
Subtotal (Total Children Is Unduplicated) 211 7672.250000 257949.7600 33.6211
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Total 7743.250000 263250.8100 33.9975
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Number of Children (Unduplicated) With at Least One Service 246
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Center 01
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 1 1.000000 50.0000 50.0000
0 0.000000 0.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 1.000000 50.0000 50.0000
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
351 5618.750000 148573.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 351 5618.750000 148573.6400 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
35 70.000000 5250.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 35 70.000000 5250.0000 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
908 2053.500000 109377.1700 109427.1700
Other 0 0.000000 0.0000 0.0000
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Total 908 2053.500000 109377.1700 109427.1700