CMS/EIP Fiscal Report Center: 02
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 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
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 50 80.50 6000.00 74.53
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 23 33.50 2512.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 37 54.00 3937.50 72.92
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 55 80.50 4329.00 53.78
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 5 7.00 525.00 75.00
Subtotal (Total Children Is Unduplicated) 113 256.50 17379.00 67.75
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EI Services,Class #03
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 2 2.00 100.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 1.00 67.88 67.88
OCCT-97530HM-OT SESSION BY OT ASST 1 1.00 54.32 54.32
Subtotal (Total Children Is Unduplicated) 4 4.00 222.20 55.55
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Total 260.50 17601.20 67.57
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Number of Children (Unduplicated) With at Least One Service 113
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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
175 260.50 17601.20 0.00
Other 0 0.00 0.00 0.00
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Total 175 260.50 17601.20 0.00