CMS/EIP Fiscal Report Center: 06
Services beginning 04/01/2025 ending 06/30/2025 Date of Report:07/19/2025 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 224 1727.000000 92895.0000 53.7898
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 50 300.000000 16146.0000 53.8200
OCCT-97530GT-OT SESSION BY LICENSED OT 1 1.000000 81.3200 81.3200
PHY-97110-PT SESSION BY LICENSED PT 3 31.000000 2520.9200 81.3200
PHY-97110GT-PT SESSION BY LICENSED PT 2 1.500000 121.9800 81.3200
PHY-97110HM-PT SESSION BY PT ASST 3 29.000000 1888.4800 65.1200
PHY-97110HMGT-PT SESSION BY PT ASST 2 12.000000 781.4400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 6.000000 487.9200 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 2 7.500000 609.9000 81.3200
Subtotal (Total Children Is Unduplicated) 266 2115.000000 115532.9600 54.6255
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Total 2115.000000 115532.9600 54.6255
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Number of Children (Unduplicated) With at Least One Service 266
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Center 06
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
2109 2115.000000 115532.9600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 2109 2115.000000 115532.9600 0.0000