CMS/EIP Fiscal Report Center: 04
Services beginning 10/01/2009 ending 12/31/2009 Date of Report:02/16/2010 Page: 1
Agency Filter:EXT
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 98 8852.00 221300.00 25.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 51 1757.00 43925.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 20 321.00 16050.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 17 113.75 7721.35 67.88
PHY-97110-PT SESSION BY LICENSED PT 41 144.75 9825.63 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 64 222.00 15069.36 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 31 42.00 554.40 13.20
Subtotal (Total Children Is Unduplicated) 170 11452.5 314445.74 27.46
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Total 11452.50 314445.74 27.46
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Number of Children (Unduplicated) With at Least One Service 170
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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
770 11452.50 314445.74 0.00
Other 0 0.00 0.00 0.00
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Total 770 11452.50 314445.74 0.00