CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2008 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 105 17468.0 157212.00 9.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 34.00 1700.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 49 224.50 15239.06 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.50 81.48 54.32
PHY-97110-PT SESSION BY LICENSED PT 22 111.25 7551.65 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 70 291.75 19803.99 67.88
SPL-92508-GROUP SPL SESSION PER CHILD 1 1.50 19.80 13.20
TRAN-TRAN-FAMILY TRANSPORTATION 3 122.00 12200.00 100.00
Subtotal (Total Children Is Unduplicated) 114 18254.5 213807.98 11.71
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Total 18254.50 213807.98 11.71
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Number of Children (Unduplicated) With at Least One Service 114
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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
649 18254.50 213807.98 0.00
Other 0 0.00 0.00 0.00
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Total 649 18254.50 213807.98 0.00