CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2021 ending 09/30/2021 Date of Report:10/13/2021 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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 3 6.000000 450.0000 75.0000
IPDEF-T1024GNTSGT-F/U PHYC AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 19 36.000000 2700.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 4 6.000000 450.0000 75.0000
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 29 53.000000 3951.0500 74.5481
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 47.000000 1175.0000 25.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 5.000000 250.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 1.000000 71.4400 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 20 22.000000 1258.4000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 2 1.500000 107.1600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 10 6.000000 342.9600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 2.500000 178.6000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 20 19.500000 1115.4000 57.2000
Subtotal (Total Children Is Unduplicated) 40 104.500000 4498.9600 43.0522
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Total 157.500000 8450.0100 53.6509
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Number of Children (Unduplicated) With at Least One Service 68
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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
28 52.000000 3900.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 28 52.000000 3900.0000 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
71 105.500000 4550.0100 4550.0100
Other 0 0.000000 0.0000 0.0000
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Total 71 105.500000 4550.0100 4550.0100