CMS/EIP Fiscal Report Statewide
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 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 5 10.000000 750.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 52.000000 3900.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 32 63.000000 4701.0500 74.6198
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 72 5765.000000 144125.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 119.000000 5950.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 16 27.000000 1928.8800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 33 83.000000 4744.2800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 27 74.750000 5340.1400 71.4400
Subtotal (Total Children Is Unduplicated) 87 6068.750000 162088.3000 26.7087
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Total 6131.750000 166789.3500 27.2009
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Number of Children (Unduplicated) With at Least One Service 118
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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
376 5941.750000 157996.4700 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 376 5941.750000 157996.4700 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
31 62.000000 4650.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 31 62.000000 4650.0000 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
10 128.000000 4142.8800 4142.8800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 10 128.000000 4142.8800 4142.8800