CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2022 ending 03/31/2022 Date of Report:04/16/2022 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 15 21.500000 1612.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 3 4.500000 337.5000 75.0000
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.1000 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 2.000000 102.1000 51.0500
Subtotal (Total Children Is Unduplicated) 22 31.000000 2205.2500 71.1371
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 157.000000 3925.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 9.000000 450.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 3.000000 150.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 31 161.750000 11555.4200 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 38 93.500000 5348.2000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 10 15.500000 1107.3200 71.4400
PHY-97110HM-PT SESSION BY PT ASST 29 132.250000 7559.4100 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 39 65.750000 4697.1800 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 57 168.500000 9638.2000 57.2000
Subtotal (Total Children Is Unduplicated) 81 807.250000 44480.7300 55.1016
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Total 838.250000 46685.9800 55.6946
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Number of Children (Unduplicated) With at Least One Service 99
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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
18 26.000000 1950.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 18 26.000000 1950.0000 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
237 812.250000 44735.9800 44771.7000
Other 0 0.000000 0.0000 0.0000
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Total 237 812.250000 44735.9800 44771.7000