CMS/EIP Fiscal Report Center: 54
Services beginning 01/01/2009 ending 03/31/2009 Date of Report:05/18/2009 Page: 1
Payclass Filters:TPIN
Eligibility Filter:Not Part C
List order: No List
Services Number of Number of Fee Reported Avg Fee
Children Units Per/Unit
Screening, Eval, and Assessment,Class #02
IPDEF-T1024TLTS-F/U PSYCH AND DEV EVAL BY EI PROF 1 1.50 112.50 75.00
IPDEI-T1024GNUK-INITIAL PSYCH AND DEV EVAL BY SPAT 1 1.50 112.50 75.00
IPDEI-T1024GOUK-INITIAL PSYCH AND DEV EVAL BY OT 8 9.00 928.13 103.13
IPDEI-T1024TL-INITIAL PSYCH AND DEV EVAL BY EI PROF 11 12.50 1837.52 147.00
Subtotal (Total Children Is Unduplicated) 17 24.50 2990.65 122.07
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Total 24.50 2990.65 122.07
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Number of Children (Unduplicated) With at Least One Service 17
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Center 54
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 5 6.50 1640.65 932.88
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
16 18.00 1350.00 0.00
Other 0 0.00 0.00 0.00
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Total 21 24.50 2990.65 932.88