CMS/EIP Fiscal Report Statewide
Services beginning 04/01/2022 ending 06/30/2022 Date of Report:08/08/2022 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 2 2.500000 187.5000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 26 48.000000 3600.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97161-PT EVAL LOW COMPLEXITY 1 1.000000 51.0500 51.0500
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.0500 51.0500
Subtotal (Total Children Is Unduplicated) 30 53.500000 3940.6500 73.6570
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 1582.000000 39550.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 3 26.000000 1300.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 4 33.000000 1650.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 27.500000 1964.6000 71.4400
OCCT-97530HM-OT SESSION BY OT ASST 26 53.000000 3031.6000 57.2000
PHY-97110-PT SESSION BY LICENSED PT 21 44.000000 3143.3600 71.4400
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 107.1600 71.4400
PHY-97110HM-PT SESSION BY PT ASST 37 101.250000 5787.4500 57.1600
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 2 1.500000 85.7400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 34 85.000000 6072.4000 71.4400
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 24 51.500000 2945.8000 57.2000
SPL-92508HA-GROUP SPL SESSION PER CHILD 7 10.500000 145.7400 13.8800
Subtotal (Total Children Is Unduplicated) 88 2016.750000 65783.8500 32.6187
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Total 2070.250000 69724.5000 33.6793
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Number of Children (Unduplicated) With at Least One Service 117
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Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
247 1507.500000 43222.5500 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 247 1507.500000 43222.5500 0.0000
Center 06
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
6 4.500000 321.4800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6 4.500000 321.4800 0.0000
Center 52
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 50.500000 3787.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 28 50.500000 3787.5000 0.0000
Center 57
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
164 507.750000 22392.9700 22392.9100
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 164 507.750000 22392.9700 22392.9100