CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2013 ending 12/31/2013 Date of Report:02/18/2014 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 20 1069.000000 26725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 118.000000 5900.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 57 449.250000 30495.0900 67.8800
PHY-97110-PT SESSION BY LICENSED PT 48 271.500000 18429.4200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 79 448.000000 30410.2400 67.8800
SPL-92508-GROUP SPL SESSION PER CHILD 9 8.500000 112.2000 13.2000
Subtotal (Total Children Is Unduplicated) 100 2364.250000 112071.9500 47.4027
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Total 2364.250000 112071.9500 47.4027
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Number of Children (Unduplicated) With at Least One Service 100
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Center 57
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
528 2364.250000 112071.9500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 528 2364.250000 112071.9500 0.0000