CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2018 ending 12/31/2018 Date of Report:02/06/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.000000 50.0000 50.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 12 24.500000 1225.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 1 0.750000 53.5800 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 1 2.250000 160.7400 71.4400
Subtotal (Total Children Is Unduplicated) 15 28.500000 1489.3200 52.2568
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Total 28.500000 1489.3200 52.2568
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Number of Children (Unduplicated) With at Least One Service 15
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Center 52
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 3 2.250000 160.7400 90.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
28 26.250000 1328.5800 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 31 28.500000 1489.3200 90.0000