CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2024 ending 03/31/2024 Date of Report:04/04/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
OCTH-97165-OT EVAL LOW COMPLEXITY 10 10.000000 471.2300 47.1230
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
PSTH-97161-PT EVAL LOW COMPLEXITY 7 7.000000 359.8700 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
SPCH-92521-EVAL OF SPEECH FLUENCY 14 14.000000 719.7400 51.4100
Subtotal (Total Children Is Unduplicated) 32 34.000000 1705.0700 50.1491
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 25 125.500000 9030.9800 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 4 28.000000 1612.8000 57.6000
PHY-97110-PT SESSION BY LICENSED PT 23 110.000000 7920.2800 72.0025
PHY-97110HM-PT SESSION BY PT ASST 5 42.000000 2406.6400 57.3010
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 26 153.500000 11045.8600 71.9600
Subtotal (Total Children Is Unduplicated) 66 459.000000 32016.5600 69.7529
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Total 493.000000 33721.6300 68.4009
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Number of Children (Unduplicated) With at Least One Service 69
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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 591 384.500000 25996.1700 14324.6600
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 2 2.000000 143.9200 0.0000
T 0 0.000000 0.0000 0.0000
0 0.000000 0.0000 0.0000
Other 205 106.500000 7581.5400 0.0000
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Total 798 493.000000 33721.6300 14324.6600