CMS/EIP Fiscal Report Statewide
Services beginning 01/01/2019 ending 03/31/2019 Date of Report:05/04/2019 Page: 1
List order: No List
Agency Filter:EIP DEI DEIP
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
PHY-97110HM-PT SESSION BY PT ASST 1 2.500000 142.9000 57.1600
Subtotal (Total Children Is Unduplicated) 1 2.500000 142.9000 57.1600
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Total 2.500000 142.9000 57.1600
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Number of Children (Unduplicated) With at Least One Service 1
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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
1 2.500000 142.9000 142.9000
Other 0 0.000000 0.0000 0.0000
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Total 1 2.500000 142.9000 142.9000