CMS/EIP Fiscal Report Center: 06
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:OTHER
Eligibility Filter:Part C (excluding not eligible)
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 6.000000 407.2800 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 5 78.000000 1029.6000 13.2000
Subtotal (Total Children Is Unduplicated) 6 84.000000 1436.8800 17.1057
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Total 84.000000 1436.8800 17.1057
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Number of Children (Unduplicated) With at Least One Service 6
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Center 06
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
45 84.000000 1436.8800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 45 84.000000 1436.8800 0.0000