CMS/EIP Fiscal Report Center: 04
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:LEA
Eligibility Filter:Part C (excluding not eligible)
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 83 2706.00 67650.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 48 1915.00 47875.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 18 312.00 15600.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 17 112.50 7636.50 67.88
PHY-97110-PT SESSION BY LICENSED PT 48 173.50 11777.18 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 65 221.00 15001.48 67.88
Subtotal (Total Children Is Unduplicated) 155 5440.00 165540.16 30.43
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Total 5440.00 165540.16 30.43
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Number of Children (Unduplicated) With at Least One Service 155
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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
646 5440.00 165540.16 0.00
Other 0 0.00 0.00 0.00
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Total 646 5440.00 165540.16 0.00