CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2024 ending 06/30/2025 Date of Report:07/19/2025 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
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 122 8740.000000 233756.0000 26.7455
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 48.000000 2592.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 17 80.500000 6546.2600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 37 381.000000 24810.7200 65.1200
PHY-97110-PT SESSION BY LICENSED PT 47 284.000000 23038.7200 81.1223
PHY-97110HM-PT SESSION BY PT ASST 25 127.000000 8096.3600 63.7509
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 598.000000 48535.7600 81.1635
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 7 74.000000 4818.8800 65.1200
Subtotal (Total Children Is Unduplicated) 123 10332.50000 352194.7000 34.0861
-----------------------------------------------------------------------------------------------------------------------
Total 10332.500000 352194.7000 34.0861
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 123
-----------------------------------------------------------------------------------------------------------------------
Center 04
Flag Claims Units Chgs Paid
---------------------------------------------------------
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
6643 10332.500000 352194.7000 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 6643 10332.500000 352194.7000 0.0000