CMS/EIP Fiscal Report Center: 01
Services beginning 10/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 13 20.75 1037.50 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 5 68.00 1700.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 60.25 3012.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 71.00 3550.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 6 43.00 2150.00 50.00
Subtotal (Total Children Is Unduplicated) 25 263.00 11450.00 43.54
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Total 263.00 11450.00 43.54
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Number of Children (Unduplicated) With at Least One Service 25
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Center 01
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
93 259.00 11250.00 0.00
Other 2 4.00 200.00 0.00
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Total 95 263.00 11450.00 0.00