CMS/EIP Fiscal Report Center: 57
Services beginning 07/01/2024 ending 09/30/2024 Date of Report:04/06/2025 Page: 1
List order: No List
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 5 5.000000 257.0500 51.4100
Subtotal (Total Children Is Unduplicated) 6 10.000000 514.1000 51.4100
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 341.000000 8559.0000 25.0997
OCCT-97530-OT SESSION BY LICENSED OT 24 84.000000 6037.4600 71.8745
OCCT-97530HM-OT SESSION BY OT ASST 27 48.000000 2822.4000 58.8000
PHY-97110-PT SESSION BY LICENSED PT 13 43.500000 3130.2600 71.9600
PHY-97110HM-PT SESSION BY PT ASST 14 43.500000 2503.8600 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 80.000000 5756.8000 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 34 74.000000 4291.2000 57.9892
Subtotal (Total Children Is Unduplicated) 63 714.000000 33100.9800 46.3599
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Total 724.000000 33615.0800 46.4297
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Number of Children (Unduplicated) With at Least One Service 64
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Center 57
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
940 724.000000 33615.0800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 940 724.000000 33615.0800 0.0000