CMS/EIP Fiscal Report Center: 01
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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 11 28.25 1412.50 50.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 8 92.00 2300.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 13 97.75 4887.50 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 97.00 4850.00 50.00
VISN-EIIF_NM-EI VISION SERVICES, IND NONMED 8 52.00 2600.00 50.00
Subtotal (Total Children Is Unduplicated) 27 367.00 16050.00 43.73
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Total 367.00 16050.00 43.73
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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
112 367.00 16050.00 0.00
Other 0 0.00 0.00 0.00
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Total 112 367.00 16050.00 0.00