CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2018 ending 03/31/2018 Date of Report:05/05/2018 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 64 5379.000000 134475.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 9 87.000000 4350.0000 50.0000
PHY-97110-PT SESSION BY LICENSED PT 18 24.500000 1750.2800 71.4400
PHY-97110HM-PT SESSION BY PT ASST 25 81.500000 4658.5400 57.1600
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 21 46.750000 3339.8200 71.4400
Subtotal (Total Children Is Unduplicated) 73 5618.750000 148573.6400 26.4425
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Total 5618.750000 148573.6400 26.4425
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Number of Children (Unduplicated) With at Least One Service 73
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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
351 5618.750000 148573.6400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 351 5618.750000 148573.6400 0.0000