CMS/EIP Fiscal Report Center: 51
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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
EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 3 7.750000 648.5700 83.6865
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 5.000000 406.6000 81.3200
Subtotal (Total Children Is Unduplicated) 5 13.750000 1136.4900 82.6538
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Total 13.750000 1136.4900 82.6538
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Number of Children (Unduplicated) With at Least One Service 5
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Center 51
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 5 3.750000 323.2900 323.2900
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
10 10.000000 813.2000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 15 13.750000 1136.4900 323.2900