CMS/EIP Fiscal Report Center: 51
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Program Patients
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 2 7.000000 378.0000 54.0000
PHY-97110-PT SESSION BY LICENSED PT 1 2.000000 162.6400 81.3200
Subtotal (Total Children Is Unduplicated) 3 9.000000 540.6400 60.0711
-----------------------------------------------------------------------------------------------------------------------
Total 9.000000 540.6400 60.0711
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 3
-----------------------------------------------------------------------------------------------------------------------
Center 51
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 7 7.000000 378.0000 378.0000
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
2 2.000000 162.6400 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 9 9.000000 540.6400 378.0000