CMS/EIP Fiscal Report Center: 04
Services beginning 07/01/2022 ending 06/30/2023 Date of Report:07/25/2023 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 69 1655.000000 41475.0000 25.0604
EIIF-T1027SCGT-EI INDIVIDUAL SESSION BY EI PROF 2 5.000000 250.0000 50.0000
PHY-97110HM-PT SESSION BY PT ASST 27 32.250000 1832.9200 56.8347
PHY-97110HMGT-PT SESSION BY LICENSED PT ASST 1 1.000000 57.1600 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 5 2.750000 197.3700 71.7709
SPL-92507GT-SPL THERAPY SESSION BY LICENSED SLP 3 1.500000 107.9400 71.9600
Subtotal (Total Children Is Unduplicated) 71 1697.500000 43920.3900 25.8736
-----------------------------------------------------------------------------------------------------------------------
Total 1697.500000 43920.3900 25.8736
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 71
-----------------------------------------------------------------------------------------------------------------------
Center 04
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 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
138 1697.500000 43920.3900 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 138 1697.500000 43920.3900 0.0000