CMS/EIP Fiscal Report Center: 02
Services beginning 07/01/2008 ending 09/30/2008 Date of Report:11/18/2008 Page: 1
Agency Filter:EXT
Payclass Filters:MED
Eligibility Filter:Part C (excluding not eligible)
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 11 18.50 1312.50 70.95
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 3 5.50 412.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 10 15.50 1087.50 70.16
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 18 29.50 1609.50 54.56
Subtotal (Total Children Is Unduplicated) 28 69.00 4422.00 64.09
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Total 69.00 4422.00 64.09
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Number of Children (Unduplicated) With at Least One Service 28
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Center 02
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
42 69.00 4422.00 0.00
Other 0 0.00 0.00 0.00
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Total 42 69.00 4422.00 0.00