CMS/EIP Fiscal Report Center: 55
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:OTHER
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 1 1.808889 97.6800 54.0000
NESF-99600-NATURAL ENVIRONMENT SUPPORT FEE 3 3.000000 36.0000 12.0000
OCCT-97530HM-OT SESSION BY OT ASST 4 10.250000 667.4800 65.1200
PHY-97110HM-PT SESSION BY PT ASST 1 4.000000 260.4800 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 3 9.000000 731.8800 81.3200
Subtotal (Total Children Is Unduplicated) 11 28.058889 1793.5200 63.9199
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Total 28.058889 1793.5200 63.9199
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Number of Children (Unduplicated) With at Least One Service 11
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Center 55
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
30 28.058889 1793.5200 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 30 28.058889 1793.5200 0.0000