CMS/EIP Fiscal Report Center: 57
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:LEA
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 1 1.000000 51.4100 51.4100
PSTF-97164-PT RE-EVAL EST PLAN CARE 1 1.000000 51.4100 51.4100
PSTH-97163-PT EVAL HIGH COMPLEXITY 3 3.000000 154.2300 51.4100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 8 13.000000 721.9300 55.5331
Subtotal (Total Children Is Unduplicated) 9 18.000000 978.9800 54.3878
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EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 26 1664.000000 44292.0000 26.6178
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 14.000000 756.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 35 118.750000 8811.8500 74.2051
OCCT-97530HM-OT SESSION BY OT ASST 47 170.500000 10807.1200 63.3849
PHY-97110-PT SESSION BY LICENSED PT 28 111.000000 8619.3600 77.6519
PHY-97110HM-PT SESSION BY PT ASST 25 113.750000 7078.5400 62.2289
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 45 207.500000 16115.7400 77.6662
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 43 114.500000 6936.0800 60.5771
Subtotal (Total Children Is Unduplicated) 85 2514.000000 103416.6900 41.1363
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Total 2532.000000 104395.6700 41.2305
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Number of Children (Unduplicated) With at Least One Service 86
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Center 57
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
3204 2532.000000 104395.6700 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 3204 2532.000000 104395.6700 0.0000