CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 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
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 87 566.000000 15282.0000 27.0000
OCCT-97530-OT SESSION BY LICENSED OT 8 10.500000 853.8600 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 34 139.500000 9084.2400 65.1200
PHY-97110-PT SESSION BY LICENSED PT 35 70.000000 5692.4000 81.3200
PHY-97110HM-PT SESSION BY PT ASST 41 80.500000 5242.1600 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 211.000000 17158.5200 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 8 36.500000 2376.8800 65.1200
Subtotal (Total Children Is Unduplicated) 93 1114.000000 55690.0600 49.9911
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Total 1114.000000 55690.0600 49.9911
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Number of Children (Unduplicated) With at Least One Service 93
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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
1662 1114.000000 55690.0600 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 1662 1114.000000 55690.0600 0.0000