CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Agency Filter:EXT
Payclass Filters:MED
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-T1027TTSC-EI GROUP SESSION BY EI PROF 7 43.00 1075.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 105 780.25 39012.50 50.00
OCCT-97530-OT SESSION BY LICENSED OT 54 193.75 13050.05 67.36
OCCT-97530HM-OT SESSION BY OT ASST 9 19.00 1032.08 54.32
PHY-97110-PT SESSION BY LICENSED PT 99 404.75 27474.43 67.88
PHY-97110HM-PT SESSION BY PT ASST 2 2.00 108.64 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 96 297.00 20132.36 67.79
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.00 108.64 54.32
SPL-92508-GROUP SPL SESSION PER CHILD 2 8.50 112.20 13.20
Subtotal (Total Children Is Unduplicated) 253 1750.25 102105.90 58.34
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Total 1750.25 102105.90 58.34
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Number of Children (Unduplicated) With at Least One Service 253
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Center 10
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
743 1750.25 102105.90 0.00
Other 0 0.00 0.00 0.00
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Total 743 1750.25 102105.90 0.00