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:TPIN
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
AUDE-92557-COMP AUDIO THRESHOLD EVAL/SPCH RECOG 1 1.000000 24.2800 24.2800
Subtotal (Total Children Is Unduplicated) 1 1.000000 24.2800 24.2800
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 87.250000 4711.5000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 3 5.000000 270.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 5.500000 447.2600 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 5 22.500000 1776.7600 78.9671
OCCT-97530HM-OT SESSION BY OT ASST 2 6.500000 423.2800 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.500000 97.6800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 12 77.750000 6282.6300 80.8055
PHY-97110GT-PT SESSION BY LICENSED PT 4 10.500000 848.0800 80.7695
PHY-97110HM-PT SESSION BY PT ASST 3 13.000000 681.4400 52.4185
PHY-97110HMGT-PT SESSION BY PT ASST 1 1.000000 65.1200 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 77.250000 6281.9700 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 12 47.000000 3822.0400 81.3200
Subtotal (Total Children Is Unduplicated) 64 354.750000 25707.7600 72.4673
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Total 355.750000 25732.0400 72.3318
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Number of Children (Unduplicated) With at Least One Service 64
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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 83 80.250000 5714.6200 5714.6200
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
293 275.500000 20017.4200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 376 355.750000 25732.0400 5714.6200