CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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
OCTH-97166-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 4 4.000000 204.2000 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 5 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 6 6.000000 306.3000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
SPCH-92610-EVAL OF ORAL,PHARYNGEAL SWALLOWING FUNC 1 1.000000 48.9400 48.9400
Subtotal (Total Children Is Unduplicated) 19 22.000000 1120.9900 50.9541
-----------------------------------------------------------------------------------------------------------------------
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 3 31.000000 3014.4600 97.2406
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1207 11625.50000 581275.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 169 701.000000 50002.2400 71.3299
OCCT-97530HM-OT SESSION BY OT ASST 13 42.250000 2416.7000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 209 836.500000 59725.2400 71.3990
PHY-97110HM-PT SESSION BY PT ASST 9 11.000000 628.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 195 1049.500000 74839.3900 71.3096
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
SPL-92508-GROUP SPL SESSION PER CHILD 3 5.000000 69.4000 13.8800
Subtotal (Total Children Is Unduplicated) 1434 14303.75000 772085.5900 53.9778
-----------------------------------------------------------------------------------------------------------------------
Total 14325.750000 773206.5800 53.9732
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 1437
-----------------------------------------------------------------------------------------------------------------------
Center 10
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 3 8.500000 585.8000 120.0000
D 0 0.000000 0.0000 0.0000
S 34 86.000000 4300.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
4565 14231.250000 768320.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 4602 14325.750000 773206.5800 120.0000