CMS/EIP Fiscal Report Center: 57
Services beginning 10/01/2011 ending 12/31/2011 Date of Report:02/16/2012 Page: 1
List order: No List
Payclass Filters:LEA
Eligibility Filter:Program Patients
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
EI Services,Class #03
ECE-ECE-EARLY CHILDHOOD EDUCATION 118 18560.00000 18560.0000 1.0000
EIGF-T1027TTSC-EI GROUP SESSION BY EI PROF 6 269.000000 6725.0000 25.0000
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 4 51.000000 2550.0000 50.0000
OCCT-97530-OT SESSION BY LICENSED OT 47 275.500000 18700.9400 67.8800
PHY-97110-PT SESSION BY LICENSED PT 27 174.000000 11811.1200 67.8800
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 51 320.500000 21755.5400 67.8800
SPL-92507HM-SPL THERAPY SESSION BY SLP ASST 1 2.000000 108.6400 54.3200
SPL-92508-GROUP SPL SESSION PER CHILD 2 5.500000 72.6000 13.2000
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 1 38.000000 19.0000 0.5000
Subtotal (Total Children Is Unduplicated) 130 19695.50000 80302.8400 4.0772
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Total 19695.500000 80302.8400 4.0772
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Number of Children (Unduplicated) With at Least One Service 130
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Center 57
Flag Claims Units Chgs Paid
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R 0 0.000000 0.0000 0.0000
U 0 0.000000 0.0000 0.0000
B 0 0.000000 0.0000 0.0000
P 0 0.000000 0.0000 0.0000
D 0 0.000000 0.0000 0.0000
S 0 0.000000 0.0000 0.0000
H 0 0.000000 0.0000 0.0000
T 0 0.000000 0.0000 0.0000
641 19695.500000 80302.8400 0.0000
Other 0 0.000000 0.0000 0.0000
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Total 641 19695.500000 80302.8400 0.0000