CMS/EIP Fiscal Report Center: 03
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.500000 121.4700 80.9800
Subtotal (Total Children Is Unduplicated) 1 1.500000 121.4700 80.9800
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 2.000000 108.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 2 5.000000 406.6000 81.3200
PHY-97110-PT SESSION BY LICENSED PT 1 6.000000 487.9200 81.3200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 23 71.000000 5393.7200 75.9679
Subtotal (Total Children Is Unduplicated) 27 84.000000 6396.2400 76.1457
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Total 85.500000 6517.7100 76.2305
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Number of Children (Unduplicated) With at Least One Service 28
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Center 03
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 1 1.000000 81.3200 81.3200
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
84 84.500000 6436.3900 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 85 85.500000 6517.7100 81.3200