CMS/EIP Fiscal Report Center: 57
Services beginning 01/01/2010 ending 03/31/2010 Date of Report:05/17/2010 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
ECE-ECE-EARLY CHILDHOOD EDUCATION 81 8316.00 74844.00 9.00
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 9 346.00 8650.00 25.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 5 100.00 5000.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 41 159.00 10792.92 67.88
PHY-97110-PT SESSION BY LICENSED PT 22 81.00 5498.28 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 53 207.25 14068.13 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 8 26.00 343.20 13.20
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 74.00 37.00 0.50
Subtotal (Total Children Is Unduplicated) 99 9309.25 119233.53 12.81
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Total 9309.25 119233.53 12.81
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Number of Children (Unduplicated) With at Least One Service 99
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Center 57
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
407 9309.25 119233.53 0.00
Other 0 0.00 0.00 0.00
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Total 407 9309.25 119233.53 0.00