CMS/EIP Fiscal Report Center: 57
Services beginning 04/01/2020 ending 06/30/2020 Date of Report:07/21/2020 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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 2 2.000000 102.1000 51.0500
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 21.000000 525.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.000000 500.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 21 311.000000 15550.0000 50.0000
OCCT-97530HM-OT SESSION BY OT ASST 1 1.500000 85.8000 57.2000
PHY-97110GT-PT SESSION BY LICENSED PT 9 22.000000 1571.6800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 1 1.500000 85.7400 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 6 5.500000 314.3800 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 1.500000 107.1600 71.4400
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 6 13.000000 928.7200 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 15 27.000000 1544.4000 57.2000
SPL-92507HMGT-SPL THERAPY SESSION BY SLP ASST 1 2.000000 114.4000 57.2000
Subtotal (Total Children Is Unduplicated) 38 416.000000 21327.2800 51.2675
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Total 418.000000 21429.3800 51.2665
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Number of Children (Unduplicated) With at Least One Service 40
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Center 57
Flag Claims Units Chgs Paid
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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
104 418.000000 21429.3800 21429.3800
Other 0 0.000000 0.0000 0.0000
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Total 104 418.000000 21429.3800 21429.3800