CMS/EIP Fiscal Report Statewide
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: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 3 6.000000 450.0000 75.0000
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 1 1.500000 83.2500 55.5000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 27 51.000000 3825.0000 75.0000
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 2 4.000000 300.0000 75.0000
Subtotal (Total Children Is Unduplicated) 33 62.500000 4658.2500 74.5320
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 21 914.000000 22850.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 15 104.000000 5200.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 8 8.000000 571.5200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 10 36.000000 2057.7600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 38.500000 2714.7200 70.5122
Subtotal (Total Children Is Unduplicated) 36 1100.500000 33394.0000 30.3444
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Total 1163.000000 38052.2500 32.7190
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Number of Children (Unduplicated) With at Least One Service 69
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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
18 50.000000 2500.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 18 50.000000 2500.0000 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 1 1.000000 75.0000 67.5000
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
32 61.500000 4583.2500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 33 62.500000 4658.2500 67.5000
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 3 16.500000 467.8800 467.8800
124 1034.000000 30426.1200 29887.2800
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 127 1050.500000 30894.0000 30355.1600