CMS/EIP Fiscal Report Center: 57
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
Screening, Eval, and Assessment,Class #02
OCTF-97168-OT RE-EVAL EST PLAN CARE 4 4.000000 232.4400 58.1100
OCTH-97167-OT EVAL HIGH COMPLEXITY 1 1.000000 58.1100 58.1100
PSTF-97164-PT RE-EVAL EST PLAN CARE 2 2.000000 116.2200 58.1100
SPCH-92521-EVAL OF SPEECH FLUENCY 3 3.000000 174.3300 58.1100
SPCH-92523-EVAL OF SPCH SOUND PROD; EVAL LANG COMP 1 1.000000 58.1100 58.1100
Subtotal (Total Children Is Unduplicated) 8 11.000000 639.2100 58.1100
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 45.000000 2430.0000 54.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 51.000007 4147.3200 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 2 27.000006 1758.2400 65.1200
PHY-97110HM-PT SESSION BY PT ASST 1 0.500000 32.5600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.000000 162.6400 81.3200
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 1 1.500000 121.9800 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 1.500000 97.6800 65.1200
Subtotal (Total Children Is Unduplicated) 15 128.500013 8750.4200 68.0966
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Total 139.500013 9389.6300 67.3092
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Number of Children (Unduplicated) With at Least One Service 22
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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 4 4.000000 325.2800 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 44 28.793509 2107.9400 2107.9400
124 106.706504 6956.4100 505.0000
Other 0 0.000000 0.0000 0.0000
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Total 172 139.500013 9389.6300 2612.9400