CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 14 26.00 1300.00 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 87.00 2175.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 12 70.75 3537.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 87.00 4350.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 79.00 3950.00 50.00
Subtotal (Total Children Is Unduplicated) 27 349.75 15312.50 43.78
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Total 349.75 15312.50 43.78
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Number of Children (Unduplicated) With at Least One Service 27
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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
122 349.75 15312.50 0.00
Other 0 0.00 0.00 0.00
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Total 122 349.75 15312.50 0.00