CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2008 ending 12/31/2008 Date of Report:02/17/2009 Page: 1
Agency Filter:EIP DEI DEIP
Payclass Filters:OTHER
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
EVAL-EVAL-DEVELOPMENTAL EVALUATION 6 6.50 333.25 51.27
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 23 32.50 2437.50 75.00
IPDEI-T1024GPUK-INITIAL PSYCH AND DEV EVAL BY PT 1 1.00 75.00 75.00
IPDEI-T1024HNUK-INITIAL PSYCH AND DEV EVAL BY ITDS 1 2.00 111.00 55.50
SPCH-92506-SPEECH EVAL BY LICENSED SLP 1 1.00 48.50 48.50
Subtotal (Total Children Is Unduplicated) 31 43.00 3005.25 69.89
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EI Services,Class #03
ASST-ASST-ASSISTIVE TECHNOLOGY 2 2.00 1100.00 550.00
CONIF-CONIF-CONSULT ITDS, FACE TO FACE 3 1.25 62.50 50.00
CONSF-CONSF-CONSULT, SLP, FACE TO FACE 1 1.00 50.00 50.00
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 1 0.50 25.00 50.00
OCCT-97530-OT SESSION BY LICENSED OT 1 0.75 50.91 67.88
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 1.50 101.82 67.88
TRAV-TRAV-PROVIDER TRAVEL TO NATURAL ENVIRONMENT 26 986.46 493.23 0.50
Subtotal (Total Children Is Unduplicated) 30 993.46 1883.46 1.90
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Total 1036.46 4888.71 4.72
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Number of Children (Unduplicated) With at Least One Service 60
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Center 52
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
74 1036.46 4888.71 0.00
Other 0 0.00 0.00 0.00
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Total 74 1036.46 4888.71 0.00