CMS/EIP Fiscal Report Center: 09
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Payclass Filters:LEA
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-IPDEF_NM-F/U PSYCH & DEV EVAL BY NON-MED PROF 2 4.00 222.00 55.50
IPDEI-IPDEI_NM-INITIAL PSYCH & DEV EVAL BY NON-MED PR 28 53.00 2941.50 55.50
Subtotal (Total Children Is Unduplicated) 30 57.00 3163.50 55.50
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 16 195.00 9750.00 50.00
Subtotal (Total Children Is Unduplicated) 16 195.00 9750.00 50.00
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Total 252.00 12913.50 51.24
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Number of Children (Unduplicated) With at Least One Service 46
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Center 09
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 1 2.00 111.00 92.50
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
90 250.00 12802.50 0.00
Other 0 0.00 0.00 0.00
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Total 91 252.00 12913.50 92.50