CMS/EIP Fiscal Report Center: 52
Services beginning 10/01/2008 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-T1024GNTS-F/U PSYCH AND DEV EVAL BY SPAT 2 3.00 100.00 33.33
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 22 34.00 1287.50 37.87
SPCH-92506-SPEECH EVAL BY LICENSED SLP 2 2.00 97.00 48.50
Subtotal (Total Children Is Unduplicated) 26 39.00 1484.50 38.06
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EI Services,Class #03
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 56 332.50 12075.00 36.32
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 14 85.00 2550.00 30.00
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 5.00 339.40 67.88
Subtotal (Total Children Is Unduplicated) 66 422.50 14964.40 35.42
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Total 461.50 16448.90 35.64
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Number of Children (Unduplicated) With at Least One Service 91
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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
190 461.50 16448.90 0.00
Other 0 0.00 0.00 0.00
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Total 190 461.50 16448.90 0.00