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
Agency Filter:EXT
Payclass Filters:OTHER
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
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 1 1.000000 51.4100 51.4100
Subtotal (Total Children Is Unduplicated) 2 2.000000 102.8200 51.4100
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EI Services,Class #03
CONOF-CONOF-CONSULT, OT, FACE TO FACE 1 1.000000 50.0000 50.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 12 123.000000 3075.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 17 97.000000 4850.0000 50.0000
EPIC-99601-Early Steps Professional Development Fee 1 1.000000 15.0000 15.0000
OCCT-97530-OT SESSION BY LICENSED OT 22 81.500000 5900.7200 72.4015
OCCT-97530HM-OT SESSION BY OT ASST 10 27.000000 1526.4000 56.5333
PHY-97110-PT SESSION BY LICENSED PT 6 18.000000 1259.3000 69.9611
PHY-97110HM-PT SESSION BY PT ASST 13 39.000000 2244.8400 57.5600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 16 31.000000 2230.7600 71.9600
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 23 63.500000 3600.0000 56.6929
Subtotal (Total Children Is Unduplicated) 62 482.000000 24752.0200 51.3527
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Total 484.000000 24854.8400 51.3530
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Number of Children (Unduplicated) With at Least One Service 62
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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 1 1.000000 50.0000 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
590 483.000000 24804.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 591 484.000000 24854.8400 0.0000