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:TPIN
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 10 85.000000 4590.0000 54.0000
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 18.000000 972.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 7.000000 569.2400 81.3200
OCCT-97530GT-OT SESSION BY LICENSED OT 4 19.000000 1536.9800 80.8937
OCCT-97530HM-OT SESSION BY OT ASST 2 3.000000 195.3600 65.1200
OCCT-97530HMGT-OT SESSION BY OT ASST 1 1.500000 65.1200 43.4133
PHY-97110-PT SESSION BY LICENSED PT 7 75.000000 5120.6800 68.2757
PHY-97110HM-PT SESSION BY PT ASST 5 28.250000 1839.6400 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 8 54.500000 4431.9400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 5 26.500000 2154.9800 81.3200
Subtotal (Total Children Is Unduplicated) 34 317.750000 21475.9400 67.5875
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Total 317.750000 21475.9400 67.5875
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Number of Children (Unduplicated) With at Least One Service 34
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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 174 168.250000 11505.7000 11505.7000
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
159 149.500000 9970.2400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 333 317.750000 21475.9400 11505.7000