CMS/EIP Fiscal Report Center: 57
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
ECE-ECE-EARLY CHILDHOOD EDUCATION 167 49680.0 447120.00 9.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 6 111.00 5550.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 52 312.00 21178.56 67.88
OCCT-97530HM-OT SESSION BY OT ASST 40 1255.50 68198.76 54.32
PHY-97110-PT SESSION BY LICENSED PT 26 171.25 11617.67 67.84
PHY-97110HM-PT SESSION BY PT ASST 35 1054.00 57253.28 54.32
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 73 401.25 27236.85 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 62 1664.50 21971.40 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 6 222.00 22200.00 100.00
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 2 152.00 76.00 0.50
Subtotal (Total Children Is Unduplicated) 178 55023.5 682402.52 12.40
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Total 55023.50 682402.52 12.40
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Number of Children (Unduplicated) With at Least One Service 178
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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
1964 55023.50 682402.52 0.00
Other 0 0.00 0.00 0.00
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Total 1964 55023.50 682402.52 0.00