CMS/EIP Fiscal Report Center: 10
Services beginning 10/01/2020 ending 12/31/2020 Date of Report:01/23/2021 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 4 4.000000 204.2000 51.0500
OCTH-97166GT-OT EVAL MODERATE COMPLEXITY 1 1.000000 51.0500 51.0500
OCTH-97167-OT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 6 6.000000 306.3000 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 3.000000 153.1500 51.0500
SPCH-92523GT-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 4 4.000000 204.2000 51.0500
SPCH-92524-BEHAV & QUAL ANALYSIS OF VOICE AND RES 12 12.000000 612.6000 51.0500
SPCH-92524GT-BEHAV & QUAL ANALYSIS OF VOICE AND RES 3 3.000000 153.1500 51.0500
Subtotal (Total Children Is Unduplicated) 34 39.000000 1990.9500 51.0500
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 4 7.000000 4319.6600 617.0943
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 408 3534.500000 176676.0000 49.9861
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 510 3428.250000 171412.5000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 132 548.000000 39149.1200 71.4400
OCCT-97530GT-OT SESSION BY LICENSED OT 41 211.500000 15109.5600 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 23 103.000000 5891.6000 57.2000
OCCT-97530HMGT-OT SESSION BY OT ASST 2 4.000000 228.8000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 211 882.250000 63027.9400 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 56 184.500000 13180.6800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 186 826.750000 58973.7200 71.3320
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 87 440.750000 31487.1800 71.4400
SPL-92507TLGT-SPL THERAPY SESSION BY LICENSED SLP 1 3.500000 250.0400 71.4400
SPL-92508-GROUP SPL SESSION PER CHILD 1 2.000000 27.7600 13.8800
Subtotal (Total Children Is Unduplicated) 1110 10176.00000 579734.5600 56.9708
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Total 10215.000000 581725.5100 56.9482
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Number of Children (Unduplicated) With at Least One Service 1114
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Center 10
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 3 10.250000 732.2600 132.5000
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
3368 10204.750000 580993.2500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3371 10215.000000 581725.5100 132.5000