CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2017 ending 12/31/2017 Date of Report:02/03/2018 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
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 69 5628.000000 140700.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 92.000000 4600.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 6 12.000000 857.2800 71.4400
PHY-97110-PT SESSION BY LICENSED PT 22 22.500000 1607.4000 71.4400
PHY-97110HM-PT SESSION BY PT ASST 27 86.750000 4958.6300 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 20 48.500000 3464.8400 71.4400
Subtotal (Total Children Is Unduplicated) 77 5889.750000 156188.1500 26.5186
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Total 5889.750000 156188.1500 26.5186
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Number of Children (Unduplicated) With at Least One Service 77
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Center 04
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
370 5889.750000 156188.1500 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 370 5889.750000 156188.1500 0.0000