CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2021 ending 06/30/2021 Date of Report:07/15/2021 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 1 2.000000 150.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 6 8.000000 600.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 9 13.500000 1012.5000 75.0000
Subtotal (Total Children Is Unduplicated) 17 25.500000 1912.5000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 147.000000 3675.0000 25.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 8 25.000000 1250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 83.500000 5965.2400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 32 52.000000 2974.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 6 9.000000 642.9600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 17 61.500000 3515.3400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 71.500000 5107.9600 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 39 125.250000 7164.3000 57.2000
Subtotal (Total Children Is Unduplicated) 63 574.750000 30295.2000 52.7102
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Total 600.250000 32207.7000 53.6571
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Number of Children (Unduplicated) With at Least One Service 80
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Center 06
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
8 4.000000 285.7600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 8 4.000000 285.7600 0.0000
Center 52
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
17 25.500000 1912.5000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 17 25.500000 1912.5000 0.0000
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
167 570.750000 30009.4400 30009.4400
Other 0 0.000000 0.0000 0.0000
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Total 167 570.750000 30009.4400 30009.4400