CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2025 ending 12/31/2025 Date of Report:01/07/2026 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
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 17 186.000000 5022.0000 27.0000
OCCT-97530-OT SESSION BY LICENSED OT 5 6.500000 528.5800 81.3200
OCCT-97530HM-OT SESSION BY OT ASST 9 23.000000 1497.7600 65.1200
PHY-97110-PT SESSION BY LICENSED PT 9 18.000000 1463.7600 81.3200
PHY-97110HM-PT SESSION BY PT ASST 6 10.000000 651.2000 65.1200
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 12 29.500000 2398.9400 81.3200
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 4 7.000000 455.8400 65.1200
Subtotal (Total Children Is Unduplicated) 22 280.000000 12018.0800 42.9217
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Total 280.000000 12018.0800 42.9217
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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 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
359 280.000000 12018.0800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 359 280.000000 12018.0800 0.0000