CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 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 59 1929.000000 49859.0000 25.8471
OCCT-97530-OT SESSION BY LICENSED OT 3 3.500000 284.6200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 10 16.500000 1285.6200 77.9164
PHY-97110HM-PT SESSION BY PT ASST 14 23.000000 1323.8800 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 14 21.500000 1654.7800 76.9665
Subtotal (Total Children Is Unduplicated) 59 1993.500000 54407.9000 27.2927
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Total 1993.500000 54407.9000 27.2927
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Number of Children (Unduplicated) With at Least One Service 59
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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
765 1993.500000 54407.9000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 765 1993.500000 54407.9000 0.0000