CMS/EIP Fiscal Report Statewide
Services beginning 07/01/2023 ending 09/30/2023 Date of Report:10/11/2023 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 13 24.500000 1837.5000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 1 2.000000 150.0000 75.0000
Subtotal (Total Children Is Unduplicated) 15 28.500000 2137.5000 75.0000
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 42 552.000000 13800.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 19.500000 1403.2200 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 3 2.000000 115.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 4 6.500000 467.7400 71.9600
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 86.3400 57.5600
PHY-97110HM-PT SESSION BY PT ASST 19 25.500000 1467.7800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 7 4.500000 323.8200 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 11.500000 662.4000 57.6000
Subtotal (Total Children Is Unduplicated) 59 623.000000 18326.5000 29.4165
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Total 651.500000 20464.0000 31.4106
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Number of Children (Unduplicated) With at Least One Service 74
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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
48 512.000000 13407.3600 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 48 512.000000 13407.3600 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
1 0.500000 35.9800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 1 0.500000 35.9800 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
15 28.500000 2137.5000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 15 28.500000 2137.5000 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
145 110.500000 4883.1600 2889.6000
Other 0 0.000000 0.0000 0.0000
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Total 145 110.500000 4883.1600 2889.6000