CMS/EIP Fiscal Report Center: 07
Services beginning 04/01/2010 ending 06/30/2010 Date of Report:08/18/2010 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
OCCT-97530-OT SESSION BY LICENSED OT 1 2.00 135.76 67.88
PHY-97110-PT SESSION BY LICENSED PT 1 4.00 271.52 67.88
Subtotal (Total Children Is Unduplicated) 2 6.00 407.28 67.88
----------------------------------------------------------------------------------------------------------------
Total 6.00 407.28 67.88
----------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 2
----------------------------------------------------------------------------------------------------------------
Center 07
Flag Claims Units Chgs Paid
-------------------------------------------------
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
2 6.00 407.28 0.00
Other 0 0.00 0.00 0.00
-------------------------------------------------
Total 2 6.00 407.28 0.00