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
Payclass Filters:LEA
Eligibility Filter:Program Patients
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 38 285.000000 7125.0000 25.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 11.000000 814.9600 74.0873
PHY-97110-PT SESSION BY LICENSED PT 24 73.500000 5323.9800 72.4351
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 43.000000 3127.0400 72.7219
Subtotal (Total Children Is Unduplicated) 38 412.500000 16390.9800 39.7357
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Total 412.500000 16390.9800 39.7357
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Number of Children (Unduplicated) With at Least One Service 38
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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
540 412.500000 16390.9800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 540 412.500000 16390.9800 0.0000