CMS/EIP Fiscal Report Center: 04
Services beginning 04/01/2025 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 57 1292.000000 34884.0000 27.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 19.500000 1585.7400 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 18 76.500000 4981.6800 65.1200
PHY-97110-PT SESSION BY LICENSED PT 22 72.000000 5855.0400 81.3200
PHY-97110HM-PT SESSION BY PT ASST 10 24.000000 1562.8800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 30 101.000000 8213.3200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 6 30.500000 1986.1600 65.1200
Subtotal (Total Children Is Unduplicated) 57 1615.500000 59068.8200 36.5638
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Total 1615.500000 59068.8200 36.5638
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Number of Children (Unduplicated) With at Least One Service 57
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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 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
1229 1615.500000 59068.8200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1229 1615.500000 59068.8200 0.0000