CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2012 ending 12/31/2012 Date of Report:02/16/2013 Page: 1
List order: No List
Agency Filter:EXT
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 7 36.000000 1439.7900 39.9942
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 21.000000 1050.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 7.000000 475.1600 67.8800
Subtotal (Total Children Is Unduplicated) 10 64.000000 2964.9500 46.3273
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Total 64.000000 2964.9500 46.3273
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Number of Children (Unduplicated) With at Least One Service 10
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Center 03
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
35 64.000000 2964.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 35 64.000000 2964.9500 0.0000