CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2025 ending 03/31/2025 Date of Report:04/06/2025 Page: 1
List order: No List
Payclass Filters:LEA
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
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 3 5.000000 290.5500 58.1100
Subtotal (Total Children Is Unduplicated) 3 5.000000 290.5500 58.1100
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 22 469.000000 12663.0000 27.0000
OCCT-97530-OT SESSION BY LICENSED OT 11 17.000000 1382.4400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 19 38.500000 2507.1200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 12 19.500000 1585.7400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 10 20.000000 1302.4000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 19 48.000000 3903.3600 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 10 10.500000 683.7600 65.1200
Subtotal (Total Children Is Unduplicated) 41 622.500000 24027.8200 38.5989
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Total 627.500000 24318.3700 38.7544
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Number of Children (Unduplicated) With at Least One Service 41
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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
775 627.500000 24318.3700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 775 627.500000 24318.3700 0.0000