CMS/EIP Fiscal Report Center: 02
Services beginning 10/01/2008 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
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 36.50 2700.00 73.97
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 6 8.50 637.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 11 16.00 1162.50 72.66
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 26 38.00 1998.00 52.58
Subtotal (Total Children Is Unduplicated) 35 99.00 6498.00 65.64
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Total 99.00 6498.00 65.64
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Number of Children (Unduplicated) With at Least One Service 35
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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
65 99.00 6498.00 0.00
Other 0 0.00 0.00 0.00
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Total 65 99.00 6498.00 0.00