CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Program Patients
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
EIGF-EIGF_NM-EI GROUP SESSION BY NONMED PROF 165 11459.0 286475.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 84 6410.00 160250.00 25.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 9 158.00 7900.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 29 674.00 33700.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 36 511.25 34703.65 67.88
PHY-97110-PT SESSION BY LICENSED PT 84 725.25 49229.97 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 113 866.25 58801.05 67.88
Subtotal (Total Children Is Unduplicated) 273 20803.8 631059.67 30.33
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Total 20803.75 631059.67 30.33
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Number of Children (Unduplicated) With at Least One Service 273
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Center 04
Flag Claims Units Chgs Paid
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R 0 0.00 0.00 0.00
U 0 0.00 0.00 0.00
B 0 0.00 0.00 0.00
P 0 0.00 0.00 0.00
D 0 0.00 0.00 0.00
S 0 0.00 0.00 0.00
H 0 0.00 0.00 0.00
T 0 0.00 0.00 0.00
2702 20803.75 631059.67 0.00
Other 0 0.00 0.00 0.00
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Total 2702 20803.75 631059.67 0.00