CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2018 ending 06/30/2018 Date of Report:08/10/2018 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
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 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 45.500000 3412.5000 75.0000
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 27 51.500000 3766.7000 73.1398
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 10 376.000000 9400.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 114.000000 5700.0000 50.0000
INTR-T1013-INTERPRETER 1 1.000000 50.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 37 163.000000 11644.7200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 66 258.500000 14786.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 13 65.000000 4643.6000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 39 219.000000 12518.0400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 175.000000 12466.2800 71.2359
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 74 316.500000 18103.8000 57.2000
Subtotal (Total Children Is Unduplicated) 117 1688.000000 89312.6400 52.9103
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Total 1739.500000 93079.3400 53.5092
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Number of Children (Unduplicated) With at Least One Service 142
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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 1 1.000000 50.0000 50.0000
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
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
21 75.000000 3235.7200 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 21 75.000000 3235.7200 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
24 47.500000 3562.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 24 47.500000 3562.5000 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
521 1616.000000 86231.1200 86094.7400
Other 0 0.000000 0.0000 0.0000
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Total 521 1616.000000 86231.1200 86094.7400