CMS/EIP Fiscal Report Center: 01
Services beginning 04/01/2009 ending 06/30/2009 Date of Report:08/25/2009 Page: 1
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 10 4.75 237.50 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 7 41.00 1025.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 10 34.50 1725.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 41.00 2050.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 7 38.00 1900.00 50.00
Subtotal (Total Children Is Unduplicated) 25 159.25 6937.50 43.56
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Total 159.25 6937.50 43.56
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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
57 159.25 6937.50 0.00
Other 0 0.00 0.00 0.00
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Total 57 159.25 6937.50 0.00