CMS/EIP Fiscal Report Center: 10
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:TPIN
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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 32 52.00 3900.00 75.00
IPDEF-T1024GOTS-F/U PSYCH AND DEV EVAL BY OT 15 22.00 1650.00 75.00
IPDEF-T1024GPTS-F/U PSYCH AND DEV EVAL BY PT 20 29.00 2175.00 75.00
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 19 31.50 2362.50 75.00
IPDEF-T1024TS-F/U PSYCH AND DEV EVAL BY ITDS 31 59.50 3302.25 55.50
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 227 402.00 30150.00 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 140 252.50 18937.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 102 158.00 11850.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 179 321.50 17843.25 55.50
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 129 197.00 14775.00 75.00
Subtotal (Total Children Is Unduplicated) 400 1525.00 106945.50 70.13
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EI Services,Class #03
OCCT-97530-OT SESSION BY LICENSED OT 2 5.75 390.31 67.88
Subtotal (Total Children Is Unduplicated) 2 5.75 390.31 67.88
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Total 1530.75 107335.81 70.12
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Number of Children (Unduplicated) With at Least One Service 402
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Center 10
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
900 1530.75 107335.81 0.00
Other 0 0.00 0.00 0.00
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Total 900 1530.75 107335.81 0.00