CMS/EIP Fiscal Report Center: 03
Services beginning 10/01/2019 ending 12/31/2019 Date of Report:02/01/2020 Page: 1
List order: No List
Payclass Filters:TPIN
Eligibility Filter:Part C (excluding not eligible)
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 7 13.000000 550.0000 42.3077
OCCT-97530-OT SESSION BY LICENSED OT 8 41.500000 2913.6200 70.2077
PHY-97110-PT SESSION BY LICENSED PT 7 19.000000 1357.3600 71.4400
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 9 38.000000 2182.6400 57.4379
Subtotal (Total Children Is Unduplicated) 30 111.500000 7003.6200 62.8127
-----------------------------------------------------------------------------------------------------------------------
Total 111.500000 7003.6200 62.8127
-----------------------------------------------------------------------------------------------------------------------
Number of Children (Unduplicated) With at Least One Service 30
-----------------------------------------------------------------------------------------------------------------------
Center 03
Flag Claims Units Chgs Paid
---------------------------------------------------------
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 70 70.500000 4567.8400 4567.8400
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
41 41.000000 2435.7800 0.0000
Other 0 0.000000 0.0000 0.0000
---------------------------------------------------------
Total 111 111.500000 7003.6200 4567.8400