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
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
OCTF-97168-OT RE-EVAL EST PLAN CARE 2 2.000000 109.5200 54.7600
OCTH-97165-OT EVAL LOW COMPLEXITY 33 40.000000 2206.4500 55.1613
OCTH-97167-OT EVAL HIGH COMPLEXITY 2 2.000000 102.8200 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 58.1100 58.1100
PSTH-97161-PT EVAL LOW COMPLEXITY 21 29.000000 1537.3400 53.0117
PSTH-97163-PT EVAL HIGH COMPLEXITY 4 4.000000 212.3400 53.0850
SPCH-92521-EVAL OF SPEECH FLUENCY 36 46.000000 2518.9600 54.7600
SPCH-92522-EVAL OF SPCH SOUND PROD 1 1.000000 51.4100 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 79 126.000000 6855.0600 54.4052
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 10.000000 540.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 42 422.500000 32382.6500 76.6453
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 71.9600 71.9600
OCCT-97530HM-OT SESSION BY OT ASST 11 120.000000 7513.6000 62.6133
PHY-97110-PT SESSION BY LICENSED PT 33 309.000000 24252.4800 78.4870
PHY-97110HM-PT SESSION BY PT ASST 10 65.000000 3911.5000 60.1769
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 44 520.500000 40955.8200 78.6855
Subtotal (Total Children Is Unduplicated) 94 1448.000000 109628.0100 75.7100
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Total 1574.000000 116483.0700 74.0045
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Number of Children (Unduplicated) With at Least One Service 101
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Center 04
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 1551 884.000000 64777.5700 22800.2500
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 38 38.000000 2670.5600 0.0000
T 0 0.000000 0.0000 0.0000
5 5.000000 263.7500 0.0000
Other 1075 647.000000 48771.1900 0.0000
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Total 2669 1574.000000 116483.0700 22800.2500