CMS/EIP Fiscal Report Center: 52
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 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 3 4.50 275.00 61.11
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 20 29.00 1637.50 56.47
Subtotal (Total Children Is Unduplicated) 23 33.50 1912.50 57.09
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EI Services,Class #03
COIFF-COIFF-IFSP CONSULT, PROF, FACE TO FACE 3 3.50 175.00 50.00
EIIF-EIIF_NM-EI INDIVIDUAL SESSION BY NONMED PROF 60 419.50 12615.00 30.07
EIIF-T1027SC-EI INDIVIDUAL SESSION BY EI PROF 8 63.00 1800.00 28.57
SPL-92507-SPL THERAPY SESSION BY LICENSED SLP 2 2.75 186.67 67.88
Subtotal (Total Children Is Unduplicated) 68 488.75 14776.67 30.23
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Total 522.25 16689.17 31.96
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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
204 522.25 16689.17 0.00
Other 0 0.00 0.00 0.00
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Total 204 522.25 16689.17 0.00