CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2019 ending 09/30/2019 Date of Report:11/04/2019 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 28 54.500000 4087.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 255.2500 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 34 63.500000 4546.9500 71.6055
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 89 2965.000000 74125.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 13.000000 928.7200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 10 10.500000 600.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 9 5.000000 357.2000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 29 48.750000 2786.5500 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 14.750000 1053.7400 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 18.500000 1058.2000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 5 2.250000 31.2300 13.8800
Subtotal (Total Children Is Unduplicated) 106 3077.750000 80941.2400 26.2988
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Total 3141.250000 85488.1900 27.2147
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Number of Children (Unduplicated) With at Least One Service 136
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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
114 2309.750000 58296.8400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 114 2309.750000 58296.8400 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
28 54.500000 4087.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28 54.500000 4087.5000 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
105 777.000000 23103.8500 23103.8500
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 105 777.000000 23103.8500 23103.8500