CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2023 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
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 37 1218.000000 30550.0000 25.0821
PHY-97110HM-PT SESSION BY PT ASST 8 4.750000 259.0200 54.5305
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 1.750000 125.9300 71.9600
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 1.500000 107.9400 71.9600
Subtotal (Total Children Is Unduplicated) 37 1226.000000 31042.8900 25.3205
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Total 1226.000000 31042.8900 25.3205
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Number of Children (Unduplicated) With at Least One Service 37
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Center 04
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
58 1226.000000 31042.8900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 58 1226.000000 31042.8900 0.0000