CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2024 ending 12/31/2024 Date of Report:03/31/2025 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
Screening, Eval, and Assessment,Class #02
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 2 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 2 1.000000 58.1100 58.1100
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 23 555.000000 14985.0000 27.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 22.250000 1753.2100 78.7960
OCCT-97530HM-OT SESSION BY OT ASST 24 66.000000 4297.9200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 18 31.000000 2520.9200 81.3200
PHY-97110HM-PT SESSION BY PT ASST 14 29.750000 1937.3200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 28 75.000000 6066.2400 80.8832
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 11 19.000000 1237.2800 65.1200
Subtotal (Total Children Is Unduplicated) 49 798.000000 32797.8900 41.1001
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Total 799.000000 32856.0000 41.1214
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Number of Children (Unduplicated) With at Least One Service 49
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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
1039 799.000000 32856.0000 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1039 799.000000 32856.0000 0.0000