CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 1 1.000000 54.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 1.000000 81.3200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 5 5.000000 379.2800 75.8560
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Total 5.000000 379.2800 75.8560
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Number of Children (Unduplicated) With at Least One Service 5
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Center 01
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 4 4.000000 297.9600 0.0000
T 0 0.000000 0.0000 0.0000
1 1.000000 81.3200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 5 5.000000 379.2800 0.0000