CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 1 1.000000 51.4100 51.4100
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 16 1140.000000 28500.0000 25.0000
EIIF-96154-HEALTH AND BEHAVIOR INTERVENTION 2 11.000000 550.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 64.000000 3200.0000 50.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 2.000000 100.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 7 39.500000 2837.2200 71.8284
OCCT-97530HM-OT SESSION BY OT ASST 5 9.500000 547.2000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 10 63.500000 4563.7400 71.8699
PHY-97110HM-PT SESSION BY PT ASST 10 54.250000 3121.0300 57.5305
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 10 81.000000 5822.7800 71.8862
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 11.500000 662.4000 57.6000
Subtotal (Total Children Is Unduplicated) 24 1476.250000 49904.3700 33.8048
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Total 1477.250000 49955.7800 33.8167
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Number of Children (Unduplicated) With at Least One Service 24
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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 3 7.500000 539.7000 539.7000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
299 1469.750000 49416.0800 49297.2800
Other 0 0.000000 0.0000 0.0000
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Total 302 1477.250000 49955.7800 49836.9800