CMS/EIP Fiscal Report Statewide
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
IPDEF-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 6 9.000000 675.0000 75.0000
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 80 134.000000 10050.0000 75.0000
IPDEI-T1024GNUKGT-INITIAL PSYCH AND DEV EVAL BY SPAT 2 4.000000 300.0000 75.0000
OCTH-97165-OT EVAL LOW COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 89 148.000000 11076.4100 74.8406
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 85 2795.000000 69975.0000 25.0358
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 4 7.000000 350.0000 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 37 86.500000 4953.9500 57.2711
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 15 83.750000 6020.1500 71.8824
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 1.500000 107.9400 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 11.500000 662.4000 57.6000
Subtotal (Total Children Is Unduplicated) 95 3173.750000 93824.7600 29.5627
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Total 3321.750000 104901.1700 31.5801
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Number of Children (Unduplicated) With at Least One Service 183
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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
138 1697.500000 43920.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 138 1697.500000 43920.3900 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
88 147.000000 11025.0000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 88 147.000000 11025.0000 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 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