CMS/EIP Fiscal Report Center: 06
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
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-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 472 3003.750000 167116.5000 55.6360
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 102 525.250000 28269.0000 53.8201
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 4 42.000000 3415.4400 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 1 1.500000 121.9800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 4 28.000000 1823.3600 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 13.000000 781.4400 60.1108
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 4 20.500000 1667.0600 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 14.500000 1179.1400 81.3200
Subtotal (Total Children Is Unduplicated) 546 3649.500000 204455.2400 56.0228
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Total 3649.500000 204455.2400 56.0228
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Number of Children (Unduplicated) With at Least One Service 546
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Center 06
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
3644 3649.500000 204455.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3644 3649.500000 204455.2400 0.0000